Doctor Evidence | Evidence Based Medicine

Evidence-Based Medicine focuses on valid and relevant evidence from well designed clinical trials for a particular diagnostic test or treatment. Evidence based medical information provides objective and scientific information about whether a specific treatment or diagnostic test works, how well it works in comparison to other treatments or tests, and what, if any, risks are associated with a therapy or test.

How does Doctor Evidence use evidence-based medical information to help you make an informed decision about your health care?

There are four steps:

Doctor Evidence will integrate your medical condition, preferences and needs into a “framed question” that is very specific for medical research. This framed question will focus on your most relevant medical need and be the basis of your Evidence-Based Medicine research packet.
An example of framed question: "Is a coronary stent, compared to open heart surgery, as effective in preventing heart attack and death in diabetics with one clogged artery?"

(Click here for more examples of framed questions)

The Doctor Evidence medical librarian(s) will search the international medical information network, using unique search engines, subscriptions, and other state-of-the-art technologies to locate evidence that will answer your framed question.

A doctor, with expertise in Evidence-Based Medicine, will then critically evaluate the evidence (abstracts and summaries of clinical studies) for its validity and relevance to your framed question. The abstracts (summaries) that answer your framed question are selected and stored for your review.

All of your medical evidence (abstracts and full text articles) will be delivered and stored in an easy-to-use Personal Evidence Portal, that is secured by your own login password. The Portal provides you with many resources to help you to understand the medical evidence. For example, the abstracts of evidence are connected to a medical dictionary that enables you to get easy to understand definitions of medical terms. At your choice we will also provide a login and portal for your primary physician so they can also have access to the medical evidence. This additional service, at no charge, enables your personal physician to evaluate and translate the evidence with you, and help you make an informed decision about your healthcare options.

Some commonly asked questions:

Q. What is critical appraisal of medical information network and why is it important to making quality health care decisions?

A. It is the objective evaluation of any information source, such as a research study, to determine whether the findings and conclusions are valid and relevant. Evidence-Based Medicine distinguishes between high and low quality evidence: The highest quality of evidence comes from well-designed randomly controlled prospective trials. Lower quality evidence comes from expert opinions without critical appraisal of the medical literature. The use of low quality medical evidence can lead to incorrect conclusions and negative medical outcomes, whereas the use of solid, high quality medical evidence can lead to positive medical outcomes.

Q. What determines whether a research study is valid and relevant?

A. Doctor Evidence will provide you with evidence from clinical studies that provide outcome data about the accuracy of a diagnostic test or the safety and effectiveness of a treatment. To make an informed decision about your healthcare options you need to evaluate the studies for validity and relevance. Studies that provide the highest levels of valid and relevant evidence will more likely help you choose the right tests and treatments for your unique medical problem. Examples of questions to ask to determine the validity and relevance of a research study are:

What is the “objective” of the study as stated in the study (usually in abstract or introduction). Does the clinical trial answer your question(s)?
In what year was the study done (how old is the study)?
What is the design of the study? (Random vs. non-random, blinded vs. non-blinded, placebo-controlled/control group vs. no placebo/control group, retrospective vs. prospective). Prospective, random, placebo-controlled trials are considered the best design for a clinical trial.
Who are the subjects in the study (for example: age, sex, medical history, geography, etc.)? Which subjects were excluded from the study?
Are the subjects in the study similar to the patient asking the question? (For example, the patient asking the question is 60 year old female, smoker, diabetic, with one tumor in her lung…are the subjects in the trial similar to this patient?)
Were the subjects in each group (for example, the treatment group vs. the placebo group) similar at the start of the study (compare age, demographics, etc as above in question 3)? The subjects in all the groups should be similar in terms of underlying medical condition, age, past medical history, etc.
What outcomes were measured and how were the outcomes identified? (Outcome examples: symptoms such as pain relief, test results such as positive influenza viral culture, effect on death rate/survival rate, etc.)
How were the outcomes measured (questionnaire, review of medical records, review of x-ray films, etc.)?
Is the outcome a “surrogate marker” or a clinical outcome “that matters”(for example did the study measure the effect of a drug on “cholesterol levels” which is a “surrogate marker” or did the study measure the drug’s effect on “heart attack rates”, which is the outcome “that matters”)
How many subjects were in each group and how many subjects completed the study? Larger trials with low drop out rates have more valid results.
How many subjects (what percentage) dropped out of the study and why? Does the study fail to explain why subjects did not complete the study (for example, many subjects drop out of study secondary to severe side effects of the treatment being researched)?
With the exception of the experimental test/treatment or placebo, were the subjects in each group treated equally (equal number of doctor visits, similar tests and treatments, etc.)?
How long was the study? Was the study long enough to capture long term or rare events/outcomes (for example if a client with cancer wants evidence about treatments that prolongs life over three years then the study should measure survival rates for at least 3 years) (Another example, a study on a new back surgery technique should have at least a two year follow-up of the subjects to determine if the surgery relieves pain for a long period of time, and to rule out unexpected side effects)?
What are the results of the study? What number and percentage of subjects in each group had a specific outcome, including positive and negative outcomes? (For example, 50% of the treatment group survived 3 years or more vs. 20% of the placebo group survived 3 years or more)
What are the conclusions of the study? How did the study determine the efficacy or effectiveness of a test or treatment? How did the study conclude that a test or treatment works or does not work?
Is the statistical analysis relevant (for example will the “p-value” help you make an informed decision about a treatment)?
Who financed and/or sponsored the research? (For example, did a pharmaceutical company finance and control the research on a new drug that they are developing?)
Is the test or treatment available in the United States and is it covered by your insurance plan?

Q. Do all doctors use Evidence-Based Medicine in their clinical practice?

A. No. Most doctors do not have the time to apply Evidence-Based Medicine to all their clinical decisions (there are over 10,000 published medical journals worldwide). In the future, we believe that all doctors will be expected to provide evidence-based justification of most medical interventions. The public will demand the evidence. Every year thousands of articles are written about EBM. Most US Medical Schools now require a course in Evidence-Based Medicine.