Margaret McCartney|Julian Treadwell|Neal Maskrey|Richard Lehman
Making evidence based medicine work for individual patients
Keele University|Cochrane
margaret mccartney colleagues argue new models evidence synthesis shared decision making needed accelerate move guideline driven care individualised care google scholar search using term evidence based medicine identifies 18 million papers two decades evidence based medicine rightfully become part fabric modern clinical practice contributed many advances healthcare many clinicians patients expressed dissatisfaction way evidence based medicine applied individuals especially primary care1 concern guidelines intended reduce variation improve quality care instead resulted medicine becoming authoritarian bureaucratic2 evidence generated large populations distilled large numbers lengthy technically complex guidelines guidelines turn used create financial incentive schemes uks quality outcomes framework whereby substantial proportion general practice income depends achieving thresholds drug therapy surrogate outcomes accordance national institute health care excellence guidelines thresholds exceed limits evidence many people also encourage clinicians ignore need elicit respect preferences goals patients guidelines grew need communicate best current evidence clinicians limitations often explicitly stated box 1 example guidelines heart failure adopt entirely disease oriented approach ignoring patients views quality remaining life need incorporate goals decision making3 depression guidelines often fail acknowledge individual patient circumstances especially adverse life events social support influences symptoms responses treatment4 box 1 problems applying population based evidence individuals