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The Story and Growth of Evidence Based Practice

Evidence Based Practice and Medicine as we commonly know it has had an interesting story so far. Although we now see it as the standard in which quality patient care should be provided, as recently as twenty years ago this was a controversial topic.

Evidence based medicine truly began to gain momentum in the late 19th century thanks to a small group of French Clinicians. French physician Claude Bernard was one of the first to begin to question the clinical efficacy of the common practice of bloodletting for pneumonia patients. Bernard helped to introduce the idea that comparative trials and experiments could have a positive effect on clinical practice. At the time, this idea was protested vigorously by a majority of physicians who believed that medicine was a form of art based solely on a physician’s intuition and experience. Popular physicians of his time believed that there was no tangible value in comparative trials and statistics.

From then on the idea advanced dramatically. Experiences during the first and second world wars led many nurses and physicians to search for ways to increase patient safety. Technological advances in the areas of sanitation, anesthesia, etc. helped to spur tremendous advances and innovations in technology and communication helped to communicate these new findings to a now global audience as current trials and experiments became easier to share, clinicians around the world began to seek out research and evidence for their clinical questions.

The following decades of the 80s, 90s, and 2000s saw the growth of the computer, the internet, and the ability to save and sort through tremendous amounts of data quickly and reliably in a way that was never before possible. By the mid-2000s the majority of large peer reviewed journals had content online and easily accessible.

Despite all of the advances, the idea of evidence based medicine still faced considerable opposition. As late as the mid-1990s, US physicians warned that evidence based practices would create cookbook style medicine and doctors who did not personalize the care to the patient. They also warned that the movement itself was an attempt by the arrogant to lower costs and make more money through health care.

It is worth mentioning that the large availability and access of information can be a double-edged sword – there exists a risk of incorrect information being spread widely. A recent example of this can be found in the false clinical trials that occurred in England concerning the links between vaccines and autism in the 90s. A study was released claiming a link between autism and the MMR vaccine. Although the study was found to be a hoax and highly altered, the information quickly spread around the globe and has been used as a crucial part of the anti-vaccine movement’s evidence.

Presently we define evidence based medicine as the capability to blend individual clinical experience and the best available external evidence. The ultimate goal being to improve patient care and patient safety within the organization. The term “best external evidence” refers to patient centered studies, trials, experiments, and data reviews that are applicable to the specific issue. Both physicians and nurses are now comfortable with the concept that patient care should be focused around the best available evidence in order to make the most appropriate decisions. In order to help “spur motivation” both physicians and nurses have a mandated amount of continuing education (CE) hours that are required each professional licensing cycle. Most continuing education providers seek to create and provide material that is focused on evidence based material for a specific topic. As we move forward, health care providers must avoid complacency – continuing measurements and observation of current practices will be the only way in which we can continue to advance the practices of medicine and nursing and improve the levels of patient care within our organizations.