The limits of evidence-based medicine.

摘要: The importance of clinical research for the practice medicine is immense and undeniable. Yet type knowledge gained from research, referred to here as "empirical evidence," itself insufficient provide optimal care. A gap exists between empirical evidence practice. Proponents evidence-based have clearly acknowledged one aspect this gap: part that requires consideration values, both patient professional, prior arriving at medical decisions. Not recognized, however, due fact not directly applicable individual patients, does answer primary question what best hand. made a conceptual error by grouping derived experience physiologic rationale under heading "evidence" then compounded developing hierarchies relegate these forms lowest rungs. Empirical evidence, when it exists, viewed "best" on which make decision, superseding rationale. But latter differ in kind, degree, do belong graded hierarchy. As they other can be complementary their incorporation necessary overcome intrinsic noted above. Clinicians, then, need incorporate 5 distinct areas into each decision: (1) (2) experiential (3) principles, (4) professional (5) system features. relative weight given predetermined, but varies case case.