Assignment: Common EBM Criticism

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Assignment: Common EBM Criticism

Assignment: Common EBM Criticism

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Copyright 2014 American Medical Association. All rights reserved.

The Connection Between Evidence-Based Medicine and Shared Decision Making

Evidence-based medicine (EBM) and shared decision making (SDM) are both essential to quality health care, yet the interdependence between these 2 approaches is not generally appreciated. Evidence-based medicine should begin and end with the patient: after finding and appraising the evidence and integrating its infer- ences with their expertise, clinicians attempt a deci- sion that reflects their patient’s values and circum- stances. Incorporating patient values, preferences, and circumstances is probably the most difficult and poorly mapped step—yet it receives the least attention.1 This has led to a common criticism that EBM ignores patients’ values and preferences—explicitly not its intention.2

Shared decision making is the process of clinician and patient jointly participating in a health decision af- ter discussing the options, the benefits and harms, and considering the patient’s values, preferences, and cir- cumstances. It is the intersection of patient-centered communication skills and EBM, in the pinnacle of good patient care (Figure).

Without shared decision making, EBM can turn into evidence tyranny.

VIEWPOINT

Tammy C. Hoffmann, PhD Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia; and University of Queensland, Brisbane, Australia.

Victor M. Montori, MD, MSc Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, Minnesota.

Chris Del Mar, MD, FRACGP Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia.

Viewpoint page 1293

Corresponding Author: Victor M. Montori, MD, MSc, Knowledge and Evaluation Research Unit, Mayo Clinic, 200 First St SW, Plummer 3-35, Rochester, MN 55905 (montori.victor @mayo.edu).

Opinion

jama.com JAMA October 1, 2014 Volume 312, Number 13 1295

Copyright 2014 American Medical Association. All rights reserved.

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Copyright 2014 American Medical Association. All rights reserved.

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