I use the term “evidence based” a lot when talking to both doctors and patients in an attempt to make a representation on what I am about and where I fit in, in the health system. However sometimes I find, especially on social media that the term gets thrown out there as something to grab your attention, to sell something or manipulate its audience and doesn’t actually make an accurate representation. It so easily becomes misrepresented by masses, causes a lot confusion, misunderstanding and ultimately can do a lot of harm. So, I thought I’d attempt clear a few things up.
Firstly, a few things that evidence based medicine (EBM) is NOT…
- It is NOT simply treatment based on case studies or anecdotes where there has been a great outcome on one person and therefore it must be great for everyone. Facebook and social media is TERRIBLE for this where literally anyone can post a testimonial or a video boasting there success with a particular product, diet, treatment technique etc. and why everyone should jump on board and do it too.
- It is NOT cherry picking the evidence only finding all the research that suits us because it closely fits what we are currently doing and reinforces it. We don’t have the right to pick and choose the evidence we like and ignore the evidence we don’t like.
- It does NOT mean we have to be limited only to doing what some randomized control studies say we are allowed to preform.
You might be surprised to know that we don’t actually have full evidence on ANYTHING! It turns out that it’s incredibly hard to prove (or disprove) anything. This includes all health and medical fields from massage to physical and manual therapy all the way to specialist medical interventions including surgery! Therefore, true evidence based practice implies a thorough UNDERSTANDING of the best available evidence and what the valuable studies are telling us. It also means that where the evidence is genuinely lacking we draw on our education and clinical experience as health care professionals to inform our patients of what we think is the most effective and safest treatment options. The ability to adapt and change our ideas and protocols when new evidence come to light is also very important.
There is a hierarchy of evidence where some studies have a rigorous and strict testing protocol to compare interventions and limit co-founding factors (other explanations that may achieve a result) allowing the truest possible findings, some that look in to the future and others look into the past, and others that simply report on an interesting case that happened and the author felt it was worth sharing. The point is, not all evidence is created equally and it takes a bit of training and education to fully understand the results.
Finally, EBM operates in a framework of genuine informed consent. For example: we bring forward to the best of our knowledge of what we think is wrong (a diagnosis), explain how we plan to treat it, and advise on alternatives i.e. What would happen if you do nothing, what would happen if your saw a medical doctor, a physiotherapist etc. etc. or options to collaborate. This allows us to give recommendations which allow patient to make an informed choice and puts the patient at the center of their treatment and recovery. This process has a profound respect for the patient as the decision maker and (as you can imagine) is very empowering for that person.