Such a generic definition can be applied to all good quality medicine. According to a more articulated definition, reported in the volume above, EBS is a continuous self-learning process in which the clinical approach for one’s patients creates in the doctor the need for important information for diagnosis, prognosis, and therapy.
Convert the need for information into precise questions that allow for an answer
Search as efficiently as possible the information that allows you to answer the questions asked, using clinical examination, laboratory and imaging, and scientific literature as sources of evidence.
- Critically evaluate the validity of the acquired evidence and its applicability to the current clinical problem.
- Apply the results of the evidence judged to be valid and relevant to the case.
- Evaluate one’s performance in solving the problems posed by the case in question.
Of these points, the second is more extensively developed in the EBS literature: how to search for information with maximum efficiency; and the third: how to interpret the articles that report the information and how to estimate its validity.
For an efficient search of information, pharmaceutical empathy based selling mainly refers to the computerized consultation of large databases, such as Medline, Embase and Cochrane Collaboration.
The EBS scientific literature devotes a lot of space to educating physicians on how and where to perform efficient computer research. This is not a new topic for McMaster University’s Department of Clinical Epidemiology and Statistics – from which Sackett hails, which was developed in a series of articles in the Annals of Internal Medicine series that began in 1985.
In fact, the main topic of the EBS literature is therapy
The constant message is that treatments must be evaluated through RCTs and that for the physician who may spend little time reading, information from meta-analyzes that provide a quantitative summary of multiple RCTs is valuable.
- A limitation of EBS is the lack of attention to diagnostic problems.
- Diagnosis is in fact an essential part of medical practice, and is in second place in frequency (after non-compliance) among the difficulties faced by general practitioners.
- The major contribution of EBS to the themes of diagnosis is a column entitled “The Rational Clinical Examination”, published in JAMA from 1992 11 to 1997 12 , with the declared aim of identifying which clinical data are or are not diagnostically reliable.
In about twenty articles there are, in this series, indications for the diagnosis of different clinical conditions, ranging from the evaluation of compliance 13 to the diagnosis of appendicitis 14 , to the detection of splenomegaly.
In some articles the effort to remain “methodologically correct” translates into a lack of practicality. This effort is evident in an article on the diagnosis of left ventricular failure, in which a very detailed analysis ends with two algorithms of dubious utility, based on the number of clinical indices detected.