Slawson D C, Shaughnessy A F
Department of Family Medicine, University of Virginia, Charlottesville 22908, USA.
BMJ. 1997 Mar 29;314(7085):947-9. doi: 10.1136/bmj.314.7085.947.
Clinicians rely heavily on expert based systems-consultation with colleagues, journal reviews and textbooks, and continuing education activities-to obtain new information. The usefulness of sources such as these depends on the relevance and validity of the information and the work it takes to obtain it. Useful information can be distinguished from the useless by asking three questions: Does the information focus on an outcome that my patients care about? Is the issue common to my practice, and is the intervention feasible? If the information is true, will it require me to change my practice? If the answer to all three questions is yes, then the information is a common POEM (patient oriented evidence that matters), capable of improving the lives of your patients and must be evaluated for validity. Conclusions based on results of well designed clinical trials are more likely to be valid than those drawn from observations based on experience in clinical practice. Both members of the team, clinicians and experts, must take responsibility for their respective roles.
临床医生严重依赖基于专家的系统——与同事会诊、查阅期刊综述和教科书以及参加继续教育活动——来获取新信息。诸如此类信息来源的有用性取决于信息的相关性和有效性以及获取信息所需的工作量。通过问三个问题可以区分有用信息和无用信息：该信息是否聚焦于我的患者关心的结果？该问题在我的临床实践中是否常见，且干预措施是否可行？如果该信息是真实的，它是否会要求我改变我的临床实践？如果这三个问题的答案都是肯定的，那么该信息就是一条常见的POEM（重要的以患者为导向的证据），能够改善患者的生活，并且必须对其有效性进行评估。基于精心设计的临床试验结果得出的结论比基于临床实践经验的观察得出的结论更有可能是有效的。团队中的临床医生和专家这两个成员都必须对各自的角色负责。
