Evidence-based individual decision making
Evidence-based individual decision making is evidence-based medicine as practiced by the individual health care provider and an individual patient. There is concern that current evidence-based medicine focuses excessively on EBID.[1]
Evidence-based individual decision making can be further divided into three modes, "doer", "user", "replicator" by the intensity of the work by the individual.[2]
This categorization somewhat parallels the theory of Diffusion of innovations, but without pejorative terms, in which adopters of innovation are categorized as innovators (2.5%), early adopters (13%), early majority (33%), late majority (33%), and laggards (16%).[3] This categorization for doctors is supported by a preliminary empirical study of Green et al. that grouped doctors into Seekers, Receptives, Traditionalists, and Pragmatists.[4] The study of Green et al. has not been externally validated.
The same doctors may vary which group they resemble depending on how much time is available to seek evidence during clinical care.[5] Medicine residents early in training tend to prefer being taught the practitioner model, whereas residents later in training tended to prefer the user model.[6]
Doer
The "doer"[2] or "practitioner"[7] of evidence-based medicine does at least the first four steps (above) of evidence-based medicine and are performed for "self-acquired"[5] knowledge.
If the Doers are the same as the "Seekers" in the study of Green, then this group may be 3% of physicians.[4]
This group may also be the similarly small group of doctors who use formal Bayesian calculations[8] or MEDLINE searches[9].
User
For the "user" of evidence-based medicine, [literature] searches are restricted to evidence sources that have already undergone critical appraisal by others, such as evidence-based guidelines or evidence summaries"[2]. More recently, the 5S search strategy,[10] which starts with the search of "summaries" (evidence-based textbooks) is a quicker approach.[11]
If the Users are the same as the "Receptives" in the study of Green, then this group may be 57% of physicians.[4]
Replicator
For the "replicator", "decisions of respected opinion leaders are followed"[2]. This has been called "'borrowed' expertise".[5]
If the Replicators are the same as the "Traditionalists" and "Pragmatists" combined in the study of Green, then this group may be 40% of physicians.[4] This is a very broad group of doctors. Possibly the lowest end of this group may be equivalent to the laggards of Rogers. This much smaller group of doctors, ones who have "severely diminished capacity for self-improvement", may be at increased risk of disciplinary action by medical boards.[12]
References
- ↑ Cite error: Invalid
<ref>tag; no text was provided for refs namedpmid15647211 - ↑ 2.0 2.1 2.2 2.3 Straus SE, McAlister FA (2000). "Evidence-based medicine: a commentary on common criticisms". CMAJ : Canadian Medical Association Journal 163: 837–41. PMID 11033714. [e]
- ↑ Berwick DM (2003). "Disseminating innovations in health care". JAMA 289: 1969–75. DOI:10.1001/jama.289.15.1969. PMID 12697800. Research Blogging.
- ↑ 4.0 4.1 4.2 4.3 Green LA, Gorenflo DW, Wyszewianski L (2002). "Validating an instrument for selecting interventions to change physician practice patterns: a Michigan Consortium for Family Practice Research study". Journal of Family Practice 51: 938–42. PMID 12485547. [e]
- ↑ 5.0 5.1 5.2 Montori VM et al. (2002). "A qualitative assessment of 1st-year internal medicine residents' perceptions of evidence-based clinical decision making". Teaching and Learning in Medicine 14: 114–8. PMID 12058546. [e]
- ↑ Akl EA et al. (2006). "EBM user and practitioner models for graduate medical education: what do residents prefer?". Medical Teacher 28: 192–4. DOI:10.1080/01421590500314207. PMID 16707306. Research Blogging.
- ↑ Guyatt GH et al. (2000). "Practitioners of evidence based care. Not all clinicians need to appraise evidence from scratch, but all need some skills". BMJ 320: 954–5. PMID 10753130. [e]
- ↑ Reid MC et al. (1998). "Academic calculations versus clinical judgments: practicing physicians' use of quantitative measures of test accuracy". Am J Med 104: 374–80. PMID 9576412. [e]
- ↑ Ely JW et al. (1999). "Analysis of questions asked by family doctors regarding patient care". BMJ 319: 358–61. PMID 10435959. [e] PubMed Central
- ↑ Cite error: Invalid
<ref>tag; no text was provided for refs namedpmid17080967 - ↑ Cite error: Invalid
<ref>tag; no text was provided for refs namedpmid17082828 - ↑ Papadakis MA et al. (2005). "Disciplinary action by medical boards and prior behavior in medical school". N Engl J Med 353: 2673–82. DOI:10.1056/NEJMsa052596. PMID 16371633. Research Blogging.