TO THE EDITOR: Evidence-based medic...

TO THE EDITOR: Evidence-based medicine (EBM) was considered a "dirty word "in a malpractice trial reported in 2004 in JAMA. (1) Dr Daniel Merenstein, a family physician, related his experience where he appropriately used EBM and shared decision making regarding prostate cancer screening. Unfortunately, this was followed through a court trial after the patient was later diagnosed with prostate cancer. The plaintiff's deliberation argued that EBM and shared decision making were not "standard of care "and won the case. Four physicians testified to this power as expert witnesses for the plaintiff.

This disheartening report (1) has stirred to a great degree discussion in the medical community. Numerous professional organizations and scientific clusters recommend care consistent with Dr Merenstein's approach, acknowledging the uncertainty in our existing understanding of prostate cancer screening, and promoting patient autonomy with informed decision making.

To deposit this malpractice trial in perspective, the result does not redress substandard medical care or malpractice, on the contrary rather demonstrates a failure of our legal system

To teachers of EBM: Do not consider this single case report (1) evidence that practicing EBM leads to malpractice claims. What is not reported is by what means many malpractice cases are obstructed by approaches using EBM and shared decision making.

To the medical community: EBM and shared decision making is standard of care if defined as being supported from most professional organizations, medical license boards, educators, and other assign places tos of patients and physicians, or through using the accepted definition of EBM as "the conscientious, explicit, and judicious use of now passing best evidence in making decisions about the care of individual patients." (2) However, EBM and shared decision making is not standard of care if it is defined as "how most numerous physicians practice." This is a tragedy and common that requires action. All physicians should have training in the skills of EBM and shared decision making, and our clinical arrangements must be modified to support these practices.

To the American public: Our tort regularity greatly needs reform. The courts are meant to provide justice, not compensation for life 's harsh realities. Justice is best serv by dint of determining the truth. EBM teaches us to systematically and critically appraise information, separating fact from bias. Legal combatants start with the desired testimony, and then find willing "experts" Bias (from the legal consultant's desired result and the expert witness's financial gain) determines the information quick in emergenciesed To provide justice based onward truth, we need a different selection proces for able witnesses. Why shouldn't our legal scheme be based on the conscientious, explicit, and judicious use of circulating best evidence in making decisions about individual cases?

BRIAN s ALPER, M.D.

Dynamic Medical Information bodys LLC

3610 Buttonwood Dr Ste200

Columbia, MO 65201

JENNIFER L HOOCK MD

Valley Family Medicine Residency

Director, Evidence-Based Medicine Project

Family Medicine Residency Network

Department of Family Medicine

receptacle 354696

University of Washington

Seattle, WA 98105-6099

REFERENCES

(1) Merenstein D.A piece of my mind. Winners and loser JAMA 2004;291:15-6

(2) Sackett DL Rosenberg WM Gray JA, Haynes RB Richardson W Evidence based medicine: what it is and what it isn't [Editorial]. BMJ 1996;312:71-2

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