Burgers Jako S
Nederlands Huisartsen Genootschap, Utrecht.
Ned Tijdschr Geneeskd. 2015;159:A8376.
This article discusses recent criticism of evidence-based medicine (EBM), which has tended to place unilateral emphasis on evidence originating from randomised trials into effectiveness. The goal of the pioneers of EBM, however, was actually the application of scientific evidence to the individual patient, including the doctor's experience ('practice-based') and the patient's preference ('preference-based') in decision making. Guidelines can support this process by systematically paying attention to patients' preferences and by presenting the advantages and disadvantages of different management options. The application of guidelines should not involve pursuit of 'standard care' but, primarily, the pursuit of shared decision making. This could lead to 'real EBM', in which medical knowledge is translated to practical choice options from different perspectives.
本文讨论了近期对循证医学（EBM）的批评，循证医学往往片面强调来自随机试验的有效性证据。然而，循证医学先驱者的目标实际上是将科学证据应用于个体患者，包括医生的经验（“基于实践”）和患者在决策中的偏好（“基于偏好”）。指南可以通过系统地关注患者的偏好并呈现不同管理选项的优缺点来支持这一过程。指南的应用不应涉及追求“标准护理”，而主要应是追求共同决策。这可能会产生“真正的循证医学”，即从不同角度将医学知识转化为实际的选择方案。
