What is evidence-based medicine?
In medicine, it is not always easy to make decisions.
Several different decisions can usually be made
in relation to examinations and treatments.
Sometimes, certain interventions do not make sense
as they do more harm than good.
The doctor has to weigh up
which examination or treatment method
is most suitable for the individual patient.
For example:
• What are the benefits and disadvantages?
• Is treatment really necessary
or can the body deal with the condition naturally?
• What alternatives are there?
The aim of evidence-based medicine is
to provide reliable answers to these questions
and therefore enable optimum treatment.
Special methods have been developed
to precisely examine the benefits of medical interventions.
These include:
• Methods that generate reliable new knowledge.
This primarily means scientific studies.
• Methods that clearly summarize existing knowledge.
• Methods that can be used to provide knowledge
to both medical professionals and laypeople.
Here, it is particularly important for the information
to be easy to both find and understand.
The decision-making process involves three areas:
• The individual clinical experience,
for example of doctors.
• The latest clinical research,
based on scientific studies
and provided in the form of high-quality guidelines, for example.
• The patient’s values and wishes.
In practice, this can mean:
A patient has frequent knee pain.
The orthopedist diagnoses osteoarthritis in his knee joint.
This can be treated in several ways.
One option is conservative treatment with physiotherapy,
which can be supplemented by the use of
painkillers, insoles, bandages or injections into the joint.
Another possibility is surgery,
where the patient is given an artificial joint.
The doctor and patient jointly consider
which option evidence-based medicine shows to be most suitable in the specific case:
• In 70 to 90 percent of patients, joint replacement
is a highly effective way of alleviating symptoms,
especially when osteoarthritis is advanced.
It offers a chance of complete recovery.
In 5 percent though, the knee becomes stiff following surgery
and in 1 percent, the knee becomes inflamed.
Also, all operations carry the risk of complications.
• Conservative treatment is somewhat less effective:
It can alleviate the symptoms for 50 to 80 percent of patients.
Complete recovery is not possible
and treatment is ongoing.
Conservative treatment can also have side effects:
Painkillers can in the long term lead to stomach problems
and increase the risk of cardiovascular diseases.
Injections into the joint can cause it to become infected.
This is admittedly rare but can be serious.
• The patient’s age also affects the decision
as prosthetic joints sometimes have to be replaced after a few years.
The younger the patient is when the prosthesis is fitted,
the higher the probability of this.
• The severity of the pain is also considered.
Surgery is more likely with severe pain
than with mild pain.
After careful consideration,
the doctor and patient decide to try conservative treatment first.
The patient is still only 55,
his pain is tolerable
and he has the motivation to do regular knee exercises.
He has also not had any stomach problems to date.
To sum up:
• It is not always clear
if medical intervention should occur.
• The potential risks and benefits
should be weighed up before any examination or treatment.
• Evidence-based medicine helps
with its specially developed methods of
creating, pooling and providing medical knowledge.
• Decisions made using evidence-based medicine
are based on the
individual experience of professionals
and the latest research.
Patients’ values and wishes are also considered.