Can Evidence-Based Medicine Be A Reality In Practice?

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Robert J. Smith, Contributing Editor

It is said that the best science is repeatable science. If you pour x into y in certain measures and under specific conditions, z will occur every time. In podiatry, such certainty is not always that certain. The treatment regimen one utilizes for the lower extremity wound of one patient with diabetes may work in healing the diabetic ulcerations of three other patients but not a fourth. Her wound might require a different therapy or a combination of therapies. Her z requires a different x and y.
However, the regimen you prescribed for your first patient should work. It has been written up in a journal and there are statistics that vouch for its success. However, your “gut,” that wisdom earned through years of practice, tells you to try something else.
Such is one of the controversial scenarios at the heart of whether podiatric practices should be doing more to incorporate the guidelines and methodologies of EBM to diagnose and treat their patients. Add to this the relatively small (albeit growing) body of published, peer-reviewed podiatric scholarship available to practitioners and one can easily surmise both ends of the spectrum when it comes to EBM in podiatry. There are those who feel the only treatments worth pursuing are those with documented proof behind them. Then there are those who, for reasons of access or simple reliance on experience, feel that EBM documentation is fine but ultimately unnecessary.
While there are intriguing views on either side of the EBM debate, the emerging consensus is that the safest ground is likely somewhere in the middle.

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