Volume 15, Number 1, March 2003
| | Evidence-based Medicine and Practice Guidelines: Solution or Problem? Part 1. Evidence-based Medicine and Evidence-based Surgery |
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Angelo Antonio Bignamini
Centre for Bioethics, School of Medicine, Sacred Heart Catholic University, Rome, Italy
Abstract
Evidence-based medicine is widely used for decision-making in the medical field; evidence-based surgery is much less used, however, due to intrinsic and extrinsic limitations, primarily the operators' variability of performance. Evidence-based medicine and evidence-based surgery are effectively used to synthesise, in practical statements and numbers, the large amount of clinical information published in the medical literature, leading to the exclusion from medical practice of objectively useless or damaging procedures. However, the risks associated with their incorrect use ought not to be overlooked. Evidence-based medicine and evidence-based surgery are physically limited by the published literature, since only well-studied procedures can become the object of undisputed external evidence.
Evidence-based medicine and evidence-based surgery are limited in their applicability to the individual patient, since the statistical inference on which they are based is applicable to populations, not to individuals. Finally, their very generation can be biased. Evidence-based medicine and evidence-based surgery can be useful tools for the education of health care workers and an effective support for planning the requisition of available medical resources.
Neither, however, can restrict the right of each patient to the best available treatment, nor should they restrict the right and duty of each physician to apply to each patient the therapeutic approach considered most suitable under the specific conditions applicable to an individual. The physician's compliance with the information originated by evidence-based medicine and evidence-based surgery can, at most, guarantee that no major mistakes have been made, rather than to have acted in the patient's best interest, and in an ethically appropriate way.
Key words: Evidence-based medicine, Methods
Asian J Oral Maxillofac Surg. 2003;15:7-13.
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