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Why Physicians' Practice May Not Be Evidence-Based

Roy Poses
Providence, RI

Evidence-based medicine may be defined as medical practice based on a critical, systematic review of the best available evidence from clinical research.

There is considerable evidence, unfortunately, that physicians may often fail to practice in this manner. In particular, physicians often fail to use treatments even in the presence of extremely strong evidence that their benefits are much larger than their harms. Further, they often use treatments known to be risky in the absence of any evidence that they are beneficial.

With Mark Chaput de Saintonge, Wally Smith, Tom Tape, and Bob Wigton, among others, we have been attempting to understand reasons for this phenomenon. One hypothesis is that physicians may base their decisions on judgments about the benefits and harms of particular treatments for individual patients. Further, these judgments could be inaccurate because physicians may fail to attend to cues that predict benefits or harms, or may attend to cues that do not predict. We have been attempting to develop case-vignette based instruments to assess how physicians judge the benefits and risks of treatments for individual patients, and the relationships of these judgments to decisions.

We have developed instruments that assess how physicians make decisions about angiotensin converting enzyme inhibitors (ACE inhibitors) for patients with congestive heart failure, and how they make decisions about lipid lowering drugs for patients with high cholesterol values and coronary artery disease.

We are trying to find funding for a large-scale field test of these instruments and to develop similar instruments for other important clinical problems whose management may not be evidence based.

Contact Roy Poses

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