Users' guides to the medical literature: XXV. Evidence-based medicine: Principles for applying the users' guides to patient care

Gordon H. Guyatt, R. Brian Haynes, Roman Z. Jaeschke, Deborah J. Cook, Lee Green, C. David Naylor, Mark C. Wilson, Scott Richardson

Research output: Contribution to journalReview article

536 Scopus citations

Abstract

This series provides clinicians with strategies and tools to interpret and integrate evidence from published research in their care of patients. The 2 key principles for applying all the articles in this series to patient care relate to the value-laden nature of clinical decisions and to the hierarchy of evidence postulated by evidence-based medicine. Clinicians need to be able to distinguish high from low quality in primary studies, systematic reviews, practice guidelines, and other integrative research focused on management recommendations. An evidence-based practitioner must also understand the patient's circumstances or predicament; identify knowledge gaps and frame questions to fill those gaps; conduct an efficient literature search; critically appraise the research evidence; and apply that evidence to patient care. However, treatment judgments often reflect clinician or societal values concerning whether intervention benefits are worth the cost. Many unanswered questions concerning how to elicit preferences and how to incorporate them in clinical encounters constitute an enormously challenging frontier for evidence-based medicine. Time limitation remains the biggest obstacle to evidence-based practice but clinicians should seek evidence from as high in the appropriate hierarchy of evidence as possible, and every clinical decision should be geared toward the particularly circumstances of the patient.

Original languageEnglish (US)
Pages (from-to)1290-1296
Number of pages7
JournalJournal of the American Medical Association
Volume284
Issue number10
DOIs
StatePublished - Sep 13 2000
Externally publishedYes

ASJC Scopus subject areas

  • Medicine(all)

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