Thoughts on ways to improve the management of professional services firms

Tuesday, January 16, 2007

Towards a Discipline of Practice - Evidence Based Medicine 1

Evidence-based medicine (EBM) is an attempt to more uniformly apply the standards of evidence gained from the scientific method, to certain aspects of medical practice. Specifically, EBM seeks to apply judgements about the inductive quality of evidence, to those aspects of medicine which depend on rational assessments of risks and benefits of treatments (including lack of treatment). According to the Centre for Evidence-Based Medicine,"Evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients."[1] Cited from Wikpedia.


In this post I want to continue my discussion on the development of a discipline of practice, a discipline focused on the way professionals practice their profession, by introducing in a preliminary way the case of evidence based medicine.

I first came across the concept in 1998 when I started as CEO of the Royal Australian (now Australian and New Zealand) College of Ophthalmologists. My instinctive first reaction was to say that's odd, I thought that all medicine was evidence based. In fact, that's far from true.

To understand this, we need to look at the way in which doctors are trained, as well as the way in which new medical approaches develop.

As with all professions, training starts with the previous body of knowledge relevant to that practice. For practical reasons, much of this has to be taken for granted. The trainee professional simply has to learn those elements required to begin practice.

The trainee then has to learn to apply that knowledge in practice. In the case of medicine this is done especially in hospitals working under the supervision of a qualified doctor who passes his/her knowledge and experience onto the trainee while checking their application. Again, the trainee is acquiring the current wisdom.

These broad processes continue throughout a professional training that can, in the case of medical specialists, extend as long twelve or thirteen years.

Once the doctor begins practice, he/she continues to learn from experience with patients. Doctors also learn through contact with other doctors and are expected to maintain a program of continuing professional education to keep them in touch with latest developments. Similar approaches and programs apply in other professional areas.

None of this will seem strange to any professional from any discipline. Yet in the case of medicine the process has proved to be seriously flawed. Evidence based medicine attempts to address these flaws.

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