I think I am like many practicing physicians in my “love-hate” relationship with clinical practice guidelines. On the one hand, it is often helpful to look up a set of evidence-based recommendations on a particular clinical issue, and I feel particularly fortunate that the American College of Cardiology and the American Heart Association have collaborated to produce high quality guidelines on a wide-range of subjects relevant to my practice. On the other hand, I am well aware of the shortcomings of practice guidelines, including the limitations of the underlying evidence base, the challenge of synthesizing the available evidence into guidelines, and the often limited applicability of recommendations to clinical practice. Continue reading Practice Guideline Overload
Physicians are encouraged, in ways large and small, to practice “evidence-based” medicine, or EBM. The Centre for Evidence Based Medicine at the University of Oxford defines EBM as “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.”
EBM is the basis for developing practice guidelines, and efforts to assess and improve the quality of care are now framed almost exclusively in terms of adherence to evidence-based practice. Continue reading How Reliable is the “Evidence Base”?