Value of Research/evidence based treatment.

Abdus Salam Khan, MD FACP
June, 2018

Emergency departments across the world provide care to vast spectrum of diseases and conditions. The teamwork required to provide the care needs to be safe care delivery especially to the most sick. As the pace of activity in the emergency department is quite high and too many decisions are made in too short span of time, it becomes more prudent to have a mechanism to ensure safety. To an outside person what seems like a chaos is all routine work to the ED staff.

As the custodian of the emergency care we all strive to be safe yet efficient, and achieving this balance is always important. Creating evidence based pathway driven care has a time tested and proven worth. All treatments that have shown benefit should be utilized and all modalities shown harm should be avoided.

These evidences come from meticulous reporting by the treating physicians, in terms of case reports, observational studies and the clinical trials. The collected data and body of information proves worthiness as well as provide treatment guidelines for the physicians. The value of research is thus in the worthiness of this body of evidence or information. If the research data is not good enough then the results will not be better by any chance. This leads to categorization of the research material into high quality and low quality evidence. Similarly according to relevance it will be highly relevant or irrelevant research. Different institutions create this system and people understand how to look at the research and what to take from it. The bottomline is how to use the research at the bedside in a meaningful way. This whole practice of medicine is called evidence based medicine (EBM). It should be at the core of our clinical practice. It comprises of the ability to trackdown in meticulous fashion and then critically evaluate the body of research and come up with the ways to update the practice of medicine.

It is always difficult to bring research to the bedside and do it is a safer and effective ways. We have to keep ourselves updated and then pick those features that have proven value and which are relevant. The institutions have this role to get into habit of developing strategies to stay on top. Review articles, bestbets, Cochrane review and clinical debates in journals are some of the ways the thought leaders bring academic or clinical research to the bedside.

As treating physicians we also have the duty to help in creating this evidence by participating in ways of documenting our practices and outcomes. Through case reports and prospective as well as retrospective studies, we let the other physicians know what has worked in our practice and what has not. Meticulous and correct data collection is one of the ways to keep our patients safe.

Last thing is the way we practice EBM. As explained above we utilize the uptodate evidence, and then we should involve the most important component of our practice, which is the patient himself. The preference of the patient and his or her customs and values should be carefully matched with the evidence and then the physician uses his/her experience to lump everything together. The treating physician has the greatest role in safeguarding the patients interest at the same time instituting the best treatment option available through keeping him/her uptodate regarding the treatment options.

Our patients rely on us for the best opinion, and we should reciprocate by practicing EBM (evidence based medicine).

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