Tonelli M R
Department of Medicine, University of Washington School of Medicine, Seattle, USA.
Acad Med. 1998 Dec;73(12):1234-40. doi: 10.1097/00001888-199812000-00011.
Evidence-based medicine (EBM) has already had a profound effect on both medical education and clinical practice. The benefits of EBM, which defines the value of medical interventions in terms of empirical evidence from clinical trials, are enormous and well described. Not clearly acknowledged, however, are the limits of EBM. An intrinsic gap exists between clinical research and clinical practice. Failure to recognize and account for this gap may lead to unintended and untoward consequences. Under the current understanding of EBM, the individuality of patients tends to be devalued, the focus of clinical practice is subtly shifted away from the care of individuals toward the care of populations, and the complex nature of sound clinical judgment is not fully appreciated. Despite its promise, EBM currently fails to provide an adequate account of optimal medical practice. A broader understanding of medical knowledge and reasoning is necessary.
循证医学（EBM）已经对医学教育和临床实践产生了深远影响。循证医学根据临床试验的经验证据来界定医学干预措施的价值，其益处巨大且已得到充分描述。然而，循证医学的局限性却未得到明确承认。临床研究与临床实践之间存在着内在差距。未能认识到并考虑到这一差距可能会导致意想不到的不良后果。按照目前对循证医学的理解，患者的个体性往往得不到重视，临床实践的重点会不知不觉地从个体护理转向群体护理，而且合理临床判断的复杂性也未得到充分认识。尽管循证医学前景广阔，但目前它仍未能充分说明最佳医疗实践。有必要对医学知识和推理有更广泛的理解。
