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Evidence‐based medicine and public health
Author(s) -
Aveyard Paul
Publication year - 1997
Publication title -
journal of evaluation in clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.737
H-Index - 73
eISSN - 1365-2753
pISSN - 1356-1294
DOI - 10.1046/j.1365-2753.1997.00095.x
Subject(s) - context (archaeology) , perspective (graphical) , health care , quality (philosophy) , public health , work (physics) , medicine , outcome (game theory) , evidence based medicine , public relations , nursing , medical education , alternative medicine , psychology , computer science , political science , engineering , epistemology , mechanical engineering , paleontology , philosophy , mathematics , mathematical economics , pathology , artificial intelligence , law , biology
Much of the everyday work of public health professionals is concerned with the implementation of evidence‐based medicine (EBM). Is this likely to improve the quality of the health service that patients' receive? In this paper, I argue that EBM is unlikely, by itself, to improve the dimensions of quality as defined by Maxwell (1994). This is because EBM relies on the individual doctor doing the right thing all of the time. Open systems theory is a way of looking at the influences of the environment on individual clinical behaviour. Using this perspective, it is easy to see why EBM will fail to improve patient care dramatically. The environment in which we work is a much bigger influence on us than we care to admit. I use some published examples to look at the way that the environment affects clinical behaviour to the detriment of the overall service quality. As public health professionals, we should be more concerned with the outcome of the service than with the specifics of a particular consultation. In this context, EBM is likely not to be a very useful tool for public health professionals.