The evidence based clinician: part 3--applying evidence to your patient
In the third part of his series, Christopher Ball looks at how to apply evidence to patients, by focusing on treatment decisions
Previously, I looked at how to ask clinical questions and where and how to find the answers rapidly. In this part, I introduce some important concepts of evidence based medicine that matter to busy clinicians and consider how to customise the evidence found to the individual needs of your patient. This is a complex area needing both clinical expertise and an understanding of the patient's values and expectations--just one of the many steps in the clinical decision making process.
Firstly, it is important to understand what evidence can and cannot tell you. Above all, it cannot tell you how to manage your patient. Studies report the effects on a group of patients, so particularising information needs careful consideration of individual factors. Also, studies are unlikely to offer guidance on the nuances of management--you can only learn this at the bedside. It is probably best to treat evidence as useful facts