There has been much buzz about this topic in recent years, but what does it really mean? The concept driving this movement of evidence based medicine (EBM) is that we should have proven scientific evidence to guide medical therapies and decision making. This habit just makes plain and perfect sense because there should be a reason behind every diagnosis and treatment we render. Not only is this best for the patient, but it is also an effective way to protect yourself from legal action. If you have evidence and literature to back what you said and did, then the arguments against you should be minimal…even in the face of a complication or bad surgical result.

I often repeat the words of Drs. Harkless and Armstrong, two of my mentors during training: “In god we trust…but all others must show DATA!” This is a good policy when it comes to new techniques, new drugs, and new concepts in medicine. All too often a representative will come to my office with a new product and show dramatic before and after case study photos…but when you ask them for study data there is very little to be had. While the absence of data should not absolutely preclude you from using a product or technique that has an obvious benefit to your patient, you should proceed with caution. For the most part, new drugs are put through rigorous testing and studied extensively before FDA approval, but this is not always the case for new products and devices.

The flip side to this argument is that “there is little to no evidence for most of what we do in the clinic and OR each day!” While there is some truth to this, many treatments (especially surgical ones) have proven themselves over time to be successful and are accepted as standard of care without randomized controlled trials to back them up. Clearly we should continue to strive for more and better data to back up what we do each day and to validate these treatments as correct. However until that level of evidence is present in all areas of medicine and surgery, I recommend you continue doing what is the accepted best practice to help your patients.

You can learn much more about EBM by clicking on THIS LINK for the lecture by Dr. Jeff Robbins:

CLICK TO VIEW

For additional reference on tools, see the American College of Foot and Ankle Surgeons ‘EBM Resource Gallery’ which can be seen at the following link: http://www.acfas.org/pubresearch/ebm/

Any stories, feedback or questions about the experiences that you've had in your residency program?  Let's make this forum more interactive. We're not looking for gems here...just the sharing of your personal experiences.  Please share your comments by sending a note to jsteinberg@podiatry.com