It is an intellectual tool or infrastructure that establishes levels of evidence and grades of recommendations in the following areas: therapy, prevention, etiology, prognosis, diagnosis, differential diagnosis, symptoms, prevalence, economic analysis and decision tree. The whole is used to develop and support “guidelines” or lines of conduct in the service of one or more medical specialties. This tool, which is sometimes very complex, is used not only for medical practice but also for surgery. Urology is no exception to the rule and many questions arise within this surgical specialty, among which we will mention the following:
Do the many surgical techniques for this type of problem really make the difference?
- What’s the best solution in the hands of the best surgeon?
- A simpler operation, achievable by the greatest number, is it not preferable for the patient?
- What type of minimally invasive surgery can we offer and in what situation?
- How to avoid that a minimally invasive treatment becomes maximally complicated?
“Free will”, synonymous with freedom, links the notion of individual will to freedom of choice. Without waking up the historical debate fueled by theologians and philosophers who dealt essentially with individual freedom as to human responsibility towards God as well as the predestination or not of acts, the modern definition of free will refers to power to choose in an absolute way, that is to say to be at the origin of his acts and their consequences. This deeply human notion concerns both the patient and the doctor in everyday life. For pharmaceutical evidence based medicine this is important.
The Difficulties for You
All the particularly difficult art of the doctor therefore consists in seeking the points of convergence between the data of his professional practice partly enacted by the structures of evidence-based medicine, his own will or decision, and freedom of choice for the patient. It is therefore essential that he replace his speech in the individual context of his patient by revisiting with good sense both his own intellectual approach and his own technical limits or those related to his art, while taking into account the expected result and the consequences of this last.
- Evidence-based medicine conceptually originated in the last quarter of the twentieth century and marks a new stage in the rational practice of medicine. Medicine, as practiced in the West, was founded by the Hippocratic school in ancient Greece with the introduction of observational clinical examination. The identification of symptoms and signs makes it possible to arrive at the diagnosis of nonsological entities (syndromes, diseases).
This approach was perfected around 1800 thanks to the anatomo-clinical comparison where the autopsy allowed the recognition of lesions leading to the symptoms and signs identified by the clinical examination. The scientific character will be reinforced around 1850 with experimental medicine invented by Claude Bernard (laboratory studies and animal models) and later with clinical studies (clinical epidemiology). The multiple and rapid advances in knowledge have resulted in an explosion of medical data which must inform practice. These data are very variable: purely experimental, observed in the patient, demonstrated by clinical studies. To help the reasoned taking of the medical decision, the concept of medicine based on facts or evidence-based medicine (“evidence-based medicine” in English) was created in the 70s.
What EBM is based on
Evidence-based medicine is based on the classification of data clinical (or facts) depending on the level of evidence of their demonstration, ranging from controlled clinical trials to the simple description of a clinical case and the opinion of an expert. Its application requires the ability to identify facts in the medical literature, either at the level of original documents, or through methodological summaries (systematic reviews, meta-analyzes, clinical practice recommendations).
This can only be done routinely by consulting computer databases and obtaining articles and reviews online free of charge. It is important to remember that evidence-based medicine is not a tool for observation, nor for research. It does not replace clinical observation and experimentation. It essentially aims to apply rationally, at the patient’s bedside and in consultation, in the medical decision (screening, diagnosis, treatment, prevention, prognosis) the data present in the literature.