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Evidence-Based Clinical Practice—Concepts & Approaches.
  1. P H MILLARD
  1. Cheam, Surrey, UK

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    Evidence-Based Clinical Practice—Concepts & Approaches. J P Geyman, RA Deyo, S D Ramsey. (Pp 177; £25.00.) Butterworth Heinemann, 1999. ISBN0-75-6-7097-5.

    The six goals of the monthly, interdisciplinary, evidence-based clinical practice rounds that underpin this book were to introduce, enable, prepare, elucidate, acquaint, and where appropriate, extend evidence-based approaches beyond care of individual patients to populations. These goals are well met. Although targeted at primary care physicians, the book could well become a must for specialist registrars as well.

    Evidence-based practice is the 21st century's buzzword. Coined in the 1980s the gold standard is the double blind trial and meta-analysis. If your ability to appraise the literature, make Medline searches, understand meta-analysis, confidence intervals, and Cochrane diagrams worries you, this book is for you. For it strikes a proper balance between cult and reality. What worries me about the cult is the notion, “before the computer there was no evidence”. I've even heard it said that there is no evidence that rehabilitation works. Yet, each time I see a specially lowered street corner or walk up ramp into a building the evidence is before my eyes.

    Also many clinical experiments are deeply flawed. Often a 1:20 chance, p<0.05, is taken as evidence. Yet the need for informed consent implies that staff as well as patients know the result that is expected. If everyone knows what the experiment is about, what chance is there that the result did not occur by chance? Evidence-based medicine is here to stay. Know the benefits and know the limitations. This book helped me to do that.

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