Sackett D L
Nuffield Department of Clinical Medicine, University of Oxford, England.
Semin Perinatol. 1997 Feb;21(1):3-5. doi: 10.1016/s0146-0005(97)80013-4.
Evidence-based medicine, whose philosophical origins extend back to mid-19th century Paris and earlier, is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. By individual clinical expertise we mean the proficiency and judgment that we individual clinicians acquire through clinical experience and clinical practice. Increased expertise is reflected in many ways, but especially in more effective and efficient diagnosis and in the more thoughtful identification and compassionate use of individual patients' predicaments, rights, and preferences in making clinical decisions about their care. By best available external clinical evidence we mean clinically relevant research, often from the basic sciences of medicine, but especially from patient centered clinical research into the accuracy and precision of diagnostic tests (including the clinical examination), the power of prognostic markers, and the efficacy and safety of therapeutic, rehabilitative, and preventive regimens. External clinical evidence both invalidates previously accepted diagnostic tests and treatment and replaces them with new ones that are more powerful, more accurate, more efficacious, and safer. Good doctors use both individual clinical expertise and the best available external evidence, and neither alone is enough. Without clinical expertise, practice risks becoming tyrannized by external evidence, for even excellent external evidence may be inapplicable to or inappropriate for an individual patient. Without current best external evidence, practice risks becoming rapidly out of date, to the detriment of patients. The practice of evidence-based medicine is a process of life-long, self-directed learning in which caring for our own patients creates the need for clinically important information about diagnosis, prognosis, therapy, and other clinical and health care issues, and in which we (1) convert these information needs into answerable questions; (2) track down, with maximum efficiency, the best evidence with which to answer them (whether from the clinical examination, the diagnostic laboratory from research evidence, or other sources); (3) critically appraise that evidence for its validity (closeness to the truth) and usefulness (clinical applicability); (4) integrate this appraisal with our clinical expertise and apply it in practice; and (5) evaluate our performance.
循证医学的哲学起源可追溯到19世纪中叶的巴黎及更早时期，它是指在为个体患者的医疗护理做决策时，审慎、明确且明智地运用当前最佳证据。循证医学实践意味着将个体临床专业知识与系统研究所提供的最佳外部临床证据相结合。我们所说的个体临床专业知识是指我们个体临床医生通过临床经验和临床实践所获得的专业技能和判断力。专业知识的提升体现在很多方面，但尤其体现在更有效、更高效的诊断上，以及在为个体患者做出护理临床决策时，更周全地识别并富有同情心考虑他们的困境、权利和偏好。我们所说的最佳外部临床证据是指临床相关研究，这些研究通常来自医学基础科学，但尤其来自以患者为中心的临床研究，涉及诊断测试（包括临床检查）的准确性和精确性、预后标志物的预测能力以及治疗、康复和预防方案的疗效和安全性。外部临床证据既能使先前被接受的诊断测试和治疗方法失效，又能用更有效、更准确、更安全的新方法取而代之。优秀的医生会同时运用个体临床专业知识和最佳外部证据，仅依靠其中任何一个都不够。没有临床专业知识，医疗实践可能会受到外部证据的左右，因为即使是出色的外部证据也可能不适用于或不适合某个个体患者。没有当前最佳外部证据，医疗实践可能很快过时，从而损害患者利益。循证医学实践是一个终身自我导向的学习过程，在这个过程中，照顾我们自己的患者产生了对有关诊断、预后、治疗以及其他临床和医疗保健问题的重要临床信息的需求，并且在这个过程中我们：（1）将这些信息需求转化为可回答的问题；（2）以最高效率找到回答这些问题的最佳证据（无论是来自临床检查、诊断实验室、研究证据还是其他来源）；（3）批判性地评估该证据的有效性（与真相的接近程度）和实用性（临床适用性）；（4）将这种评估与我们的临床专业知识相结合并应用于实践；（5）评估我们的表现。
