{"id":3040,"date":"2017-03-29T13:32:45","date_gmt":"2017-03-29T12:32:45","guid":{"rendered":"https:\/\/bestpractice.bmj.com\/?page_id=3040"},"modified":"2026-01-20T17:17:33","modified_gmt":"2026-01-20T16:17:33","slug":"what-does-evidence-based-actually-mean","status":"publish","type":"page","link":"https:\/\/bestpractice.bmj.com\/info\/us\/evidence\/discuss-ebm\/what-does-evidence-based-actually-mean\/","title":{"rendered":"What does evidence-based actually mean?"},"content":{"rendered":"

‘Surely all medicine practiced today is evidence-based.’ <\/em><\/p>
\r\n

or<\/p>
\r\n

‘EBM just means blindly following guideline recommendations and trial results. It allows no place for professionalism, it is too rigid, and it does not “fit” the patient in front of me.’<\/em><\/p>
\r\n

Neither of these assumptions is true. The first one denies\u2014against all evidence\u2014that a problem exists, and the second is far from what the founders of EBM described<\/a>.<\/p>
\r\nLooking back to the publications on EBM from the early 1990s onwards gives a perspective of the serious issues they were tackling, and the desire to make this fun, as well as easy to understand and adopt<\/a>. Rereading the original papers, it is disappointing to reflect on how little the paradigm has shifted<\/a>.
\r\n
\r\nWhy? I would argue that adopting evidence-based practice (EBP) does not come easily to many. It requires us to be sceptical, to question our knowledge and beliefs, to identify the key questions, and to not be afraid to admit we don\u2019t have all the answers.
\r\n
\r\nThere are facts in medicine in the science of anatomy, physiology, pharmacology, etc; however, medicine is often referred to as an art, and treatment choices are exactly that\u2014a choice. Therefore, within medical practice, decisions are constantly being made. EBM is about making those decisions transparent and reducing bias as much as possible. Not just bias in study results, although this is an important area, but equally important is involving everyone in the decision: a multidisciplinary team which includes the patient, and their values and preferences, at its heart. By identifying where a decision is being made, acknowledging and communicating the choices involved and their implications, the best decision can be reached for and with an individual.
\r\n
\r\nWhich brings me to guidelines. It is concerning that, in trying to support an evidence-based approach, guidelines seem to be increasingly seen as directives and not what they set out to be\u2014guidance. At the start of every NICE guideline you will find the following:
\r\n
\r\n‘The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The application of the recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and\/or their carer or guardian.’<\/em>
\r\n
\r\nIs this caveat even read, let alone heeded to by the many who just skip to the summary of recommendations? Are doctors today so time-poor that their only option is to be spoon-fed information and blindly follow what they are told? I hope desperately that this isn\u2019t the case.
\r\n
\r\nSo can EBM work in practice, and would it make any difference? One study<\/a> found that regularly and systematically raising clinical questions through critically appraised topics (CATs) and best evidence topics (BETs)<\/a>, resulted in better patient outcomes compared to a traditional approach. A promising start to the evidence for the effectiveness of EBP.
\r\n
\r\nThe original EBM articles gave as much importance to evidence, as to the healthcare professional\u2019s knowledge and experience, and the patient\u2019s value and preferences\u2014the intersection of this Venn diagram being EBM. Perhaps the focus has been too much on defining evidence, and EBM may have in certain circles become more of an academic pursuit. This was never the intention<\/a>, and things are changing with a new focus in recent years on implementation, knowledge translation, and shared decision making<\/a>. If the resulting new processes and tools are informative, without being overly prescriptive, then maybe there is a way in the future for all healthcare to be truly evidence-based.
\r\n
\r\nAuthor: Caroline Blaine<\/strong>
\r\n
\r\nRead more<\/a>","protected":false},"excerpt":{"rendered":"

‘Surely all medicine practiced today is evidence-based.’  or ‘EBM just means blindly following guideline recommendations and trial results. It allows no place for professionalism, it is too rigid, and it does not “fit” the patient in front of me.’ Neither of these assumptions is true. The first one denies\u2014against all evidence\u2014that a problem exists, and […]<\/p>\n","protected":false},"author":3,"featured_media":0,"parent":3027,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"marketing_new.php","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-3040","page","type-page","status-publish","hentry"],"acf":{"components":[{"choose_component":"generic","hide":"","logged_in":["yes"],"logged_out":"","grey_background":"","background_color":"","background_image":null,"title_text_color":"","title":"What does evidence based actually mean?","text":"

\u201cSurely all medicine practised today is evidence based.\u201d\u00a0<\/em><\/h1>\r\n

or<\/h1>\r\n

\u201cEBM just means blindly following guideline recommendations and trial results. It allows no place for professionalism, it is too rigid, and it does not 'fit' the patient in front of me.\u201d<\/em><\/h1>\r\n

Neither of these assumptions is true. The first one denies\u2014against all evidence\u2014that a problem exists, and the second is far from what the founders of EBM described.<\/p>\r\nLooking back to the publications on EBM from the early 1990s onwards gives a perspective of the serious issues they were tackling, and the desire to make this fun, as well as easy to understand and adopt<\/a>. Rereading the original papers, it is disappointing to reflect on how little the paradigm has shifted.\r\n\r\nWhy? I would argue that adopting evidence-based practice (EBP) does not come easily to many. It requires us to be sceptical, to question our knowledge and beliefs, to identify the key questions, and to not be afraid to admit we don\u2019t have all the answers.\r\n\r\nThere are facts in medicine in the science of anatomy, physiology, pharmacology, etc; however, medicine is often referred to as an art, and treatment choices are exactly that\u2014a choice. Therefore, within medical practice, decisions are constantly being made. EBM is about making those decisions transparent and reducing bias as much as possible. Not just bias in study results, although this is an important area, but equally important is involving everyone in the decision: a multidisciplinary team which includes the patient, and their values and preferences, at its heart. By identifying where a decision is being made, acknowledging and communicating the choices involved and their implications, the best decision can be reached for and with an individual.\r\n\r\nWhich brings me to guidelines. It is concerning that, in trying to support an evidence-based approach, guidelines seem to be increasingly seen as directives and not what they set out to be\u2014guidance. At the start of every NICE guideline you will find the following:\r\n\r\n\u201cThe recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The application of the recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and\/or their carer or guardian.\u201d<\/em>\r\n\r\nIs this caveat even read, let alone heeded to, by the many who just skip to the summary of recommendations? Are doctors today so time-poor that their only option is to be spoon-fed information and blindly follow what they are told? I hope desperately that this isn\u2019t the case.\r\n\r\nSo can EBM work in practice, and would it make any difference? One study<\/a> found that regularly and systematically raising clinical questions through critically appraised topics (CATs) and best evidence topics (BETs)<\/a>, resulted in better patient outcomes compared to a traditional approach. A promising start to the evidence for the effectiveness of EBP.\r\n\r\nThe original EBM articles gave as much importance to evidence, as to the healthcare professional\u2019s knowledge and experience, and the patient\u2019s value and preferences\u2014the intersection of this Venn diagram being EBM. Perhaps the focus has been too much on defining evidence, and EBM may have in certain circles become more of an academic pursuit. This was never the intention, and things are changing with a new focus in recent years on implementation, knowledge translation, and shared decision making<\/a>. If the resulting new processes and tools are informative, without being overly prescriptive, then maybe there is a way in the future for all healthcare to be truly evidence-based.\r\n\r\nAuthor: Caroline Blaine<\/strong>","image":null,"qr_image":null,"circular_image":null,"button_text":"Read more","button_url":"https:\/\/bestpractice.bmj.com\/info\/us\/evidence\/ebm-toolbox\/bibliography\/","button2_text":"","button2_url":"","video_embed":"","quote":"","quote_author":"","author_job_title":"","feature_iconsimages":null,"bullets":"none","bullet_text":null,"expiration_date":null,"review_type":"normal","reviews":null,"feature_image_cards":null,"feature_icon_cards":null,"podcast_date":null,"podcast_title":"","podcast_text":"","podcast_embed_script":"","campaign_advert_link":"","monthly":{"show_monthly_tab":false,"strikethrough_price":"","price_text":"","per_month_text":"","vat_text":"","subscribe_button_text":"","subscribe_button_link":""},"annual":{"show_annual_tab":false,"packages":null,"default_price":"","default_strikethrough_price":"","default_per_year_text":"","vat_text":"","subscribe_button_text":"","subscribe_button_link":""},"advisory_panel":null,"article_list_fields":null,"subscription_tab_main_heading":"","subscription_tabs":null,"accordion_for_page":null,"embed_code":""},{"choose_component":"bulletList","hide":"","logged_in":["yes"],"logged_out":"","grey_background":[],"background_color":"","background_image":null,"title_text_color":"","title":"Related links","text":"","image":null,"qr_image":null,"circular_image":null,"button_text":"","button_url":"","button2_text":"","button2_url":"","video_embed":"","quote":"","quote_author":"","author_job_title":"","feature_iconsimages":null,"bullets":"ticks","bullet_text":[{"text_data":"What is the best evidence and how to find it<\/a>","bullet_icon_url":""},{"text_data":"Simply making evidence simple<\/a>","bullet_icon_url":""},{"text_data":"Six proposals for EBMs future<\/a>","bullet_icon_url":""},{"text_data":"Promoting informed healthcare choices by helping people assess treatment claims<\/a>","bullet_icon_url":""},{"text_data":"The blind leading the blind in the land of risk communication<\/a>","bullet_icon_url":""},{"text_data":"Transforming the communication of evidence for better health<\/a>","bullet_icon_url":""},{"text_data":"Clinical search, big data, and the hunt for meaning<\/a>","bullet_icon_url":""},{"text_data":"Living systematic reviews: towards real-time evidence for health-care decision making<\/a>","bullet_icon_url":""},{"text_data":"The rise of rapid reviews<\/a>","bullet_icon_url":""},{"text_data":"Evidence for the Brave New World on multimorbidity<\/a>","bullet_icon_url":""},{"text_data":"Genetics and personalized medicine: where\u2019s the revolution?<\/a>","bullet_icon_url":""},{"text_data":"Policy, practice, and politics<\/a>","bullet_icon_url":""},{"text_data":"The straw men of integrative health and alternative medicine<\/a>","bullet_icon_url":""},{"text_data":"Where\u2019s the evidence for teaching evidence-based medicine?<\/a>","bullet_icon_url":""}],"expiration_date":null,"review_type":"normal","reviews":null,"feature_image_cards":null,"feature_icon_cards":null,"podcast_date":null,"podcast_title":"","podcast_text":"","podcast_embed_script":"","campaign_advert_link":"","monthly":{"show_monthly_tab":false,"strikethrough_price":"","price_text":"","per_month_text":"","vat_text":"","subscribe_button_text":"","subscribe_button_link":""},"annual":{"show_annual_tab":false,"packages":null,"default_price":"","default_strikethrough_price":"","default_per_year_text":"","vat_text":"","subscribe_button_text":"","subscribe_button_link":""},"advisory_panel":null,"article_list_fields":null,"subscription_tab_main_heading":"","subscription_tabs":null,"accordion_for_page":null,"embed_code":""},{"choose_component":"generic","hide":"","logged_in":"","logged_out":["yes"],"grey_background":"","background_color":"","background_image":null,"title_text_color":"","title":"Log in or subscribe to access all of BMJ Best Practice","text":"