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The Importance of Evidence-Based Medicine

If you're ever diagnosed with a serious medical condition, such as heart disease, you want to make sure you receive the best treatment available. But what is that? Is it medication and lifestyle changes alone? Having a stent put in? Having bypass surgery?

To help you make an informed decision, it's important to rely on evidence-based medicine (EBM). Using EBM means that you and your doctor decide on your treatment based on the most proven science available. Because when it comes to your health, you want what's been shown to work best.

What EBM is
Contrary to its name, EBM isn't just about evidence. It includes three parts:

  • The best research available. Generally, EBM guidelines are based on the analysis of multiple large, well-designed studies on the same topic.
  • The doctor's expertise. The doctor uses his or her experience and education, along with EBM guidelines, to make informed medical decisions.
  • The patient's values. As a patient, you share in the decision-making process about your medical care.

How EBM benefits you
Better care—that's what EBM means for you. Numerous studies have shown that practicing EBM improves patients' health, reduces complications, and saves lives. Here's how to help ensure you get the best care possible:

  • If you have a health condition, talk to your doctor about the various treatment options available and the evidence behind each one.
  • Search for medical information from organizations that promote EBM, such as Take any questions to your doctor.
  • Be involved in your own health—know your health history and your numbers (blood pressure, cholesterol, weight).

How EBM works
In the past, doctors who practiced EBM typically had to evaluate research themselves, either searching through their own textbooks, at libraries, or online. Now, with the Web and electronic health records, practicing EBM has become more convenient for doctors. There are large online databases that doctors can easily search for information on standard guidelines based on EBM. Also, if using electronic health records, a doctor can download EBM templates that prompt him or her about certain tests and medications recommended for patients with a specific condition, such as heart disease.

How one doctor practices EBM
Chris Campanile, M.D., of Hillside Family Medicine in Pawtucket, Rhode Island, says that his practice has made EBM part of their electronic health records system. "When I see patients with diabetes, there's a template I use that automatically prompts me to make sure that they had an eye exam, that they had their LDL checked, or that they're on certain medications," says Dr. Campanile. "This is something that I believe strongly in, that you have to have these kinds of prompts to make sure everything gets done. Otherwise, one out of 10 things will get dropped."

What doctors think about EBM
"There's an art and a science to medicine," says David Gorelick, M.D., of Aquidneck Medical Associates, a patient-centered medical home with practices in Newport and Portsmouth, Rhode Island. "EBM is the science part. The doctor practicing medicine is the art."

EBM is important because the evidence is always changing, says Dr. Gorelick. "Medicines are developed that the FDA says are safe. Medical authorities and advisory boards recommend the use of these medicines. But maybe over time we find out they aren't as beneficial as we originally thought. That happened with post-menopausal hormones for women. So we have to shift."

Dr. Campanile works with his colleagues to help them develop processes of care based on EBM. "I've met with lots of doctors who say, 'I know these procedures up and down, and I don't need reminders about them,'" says Dr. Campanile. "I ask if I can do a spot audit on 30 charts, and invariably about 75 percent of the time they didn't do everything they should have. It's not because they didn't know things—it's because they were busy or something got lost or the patient hasn't been in for 18 months." He says that doctors are seeing the benefit of EBM because of the good scientific research behind it.

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The Importance of Evidence-Based Medicine

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What BCBSRI is doing
Blue Cross & Blue Shield of Rhode Island (BCBSRI) will be promoting EBM later this year by offering new EBM content to members through and making EBM patient information tools available to doctors. In the future, doctors will also be able to download the tools into their electronic health records. In all patient-centered medical homes supported by BCBSRI, doctors must practice EBM.
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