Revealing Evidence-Based Practice

It was nothing less than provocative eye candy. My classmates and I stared at the foldout, the likes of which we had never seen. Vibrant colors stared back. The reds, blues, and yellows jumped from the page. It was a pinup begging to be pinned up. In 1979, the Canadian Medical Association Journal had published the recommendations of the Canadian Task Force on the Periodic Health Examination [1]. Along with 26 pages of tables, this 4-page foldout was published, not in black and white, but in color. Including recommendations for pregnant women from 1–13 weeks to term, children from birth to 18 years, young adults, and seniors 75 years and older, these guidelines were comprehensive; the elements of the periodic health exam had been reviewed and rated based on the evidence supporting each. Recommendations in red had the best evidence and those in blue had the next-best evidence; recommendations in yellow had little or no proof of value, but seemed like good ideas. That anticipatory guidance was simply a “good idea” and not colored red was a shock; for us in training, it was also verification that our lack of skill in answering parents' earnest questions was not a critical failure. These recommendations were not the first and certainly not the last meant to guide physicians towards evidence-based interventions. But rendering them on 4 pages suitable for hanging was so practical and helpful that this seemed like the wave of the future. And it was. For a time, clinical guidelines…