Buetow Stephen, Upshur Ross, Miles Andrew, Loughlin Michael
Department of General Practice and Primary Health Care, University of Auckland, Private Bag, Auckland, New Zealand.
J Eval Clin Pract. 2006 Aug;12(4):399-404. doi: 10.1111/j.1365-2753.2006.00617.x.
Tough but constructive criticisms of evidence-based medicine (EBM) have without doubt informed the evolution and serial reconstitutions of this approach to clinical decision making and behaviour. Yet, concerns about EBM persist and as EBM changes in response to reflection and criticism, so too do the criticisms themselves. This paper describes our current understanding of EBM and, to identify opportunities for the continuing evolution of EBM, discusses some key attributes of EBM that still or now cause us concern. Specifically, these attributes are the nature of evidence in EBM; the unknown effectiveness of EBM; the clinician-centric focus of EBM; and the potential of EBM to harm patients.
对循证医学（EBM）严厉但具建设性的批评无疑为这种临床决策和行为方法的演变及系列重构提供了依据。然而，对循证医学的担忧依然存在，并且随着循证医学因反思和批评而发生变化，批评本身也在改变。本文描述了我们目前对循证医学的理解，并为确定循证医学持续演变的机会，讨论了循证医学中仍然或现在引起我们关注的一些关键特性。具体而言，这些特性包括循证医学中证据的性质；循证医学未知的有效性；循证医学以临床医生为中心的关注点；以及循证医学对患者造成伤害的可能性。
