Evidence-based individual decision making
Evidence-based individual decision making is evidence-based medicine (EBM) as practiced by the individual health care provider and an individual patient. This is in contrast to Evidence-based guidelines which is EBM at the organizational or institutional level, and involves producing guidelines, policy, and regulations. There is concern that current evidence-based medicine focuses excessively on EBID.
Evidence-based individual decision making can be divided into three modes: "doer", "user", "replicator" by the intensity of the work by the individual.This categorization somewhat parallels the theory of Diffusion of innovations, but without pejorative terms, in which adopters of innovation are categorized as innovators (2.5%), early adopters (13%), early majority (33%), late majority (33%), and laggards (16%). This categorization for doctors is supported by a preliminary empirical study of Green et al. that grouped doctors into Seekers, Receptives, Traditionalists, and Pragmatists. (The study of Green et al. has not been externally validated.) The same doctors may operate in different modes depending on how much time is available to seek evidence during clinical care. Medicine residents early in training tend to prefer being taught the practitioner model, whereas residents later in training tended to prefer the user model.
The "doer" or "practitioner" of evidence-based medicine does at least the first four steps (above) of evidence-based medicine and are performed for "self-acquired" knowledge. If the Doers are the same as the "Seekers" in the study of Green, then this group may be 3% of physicians. This group may also be the similarly small group of doctors who use formal Bayesian calculations or MEDLINE searches.
For the "user" of evidence-based medicine, [literature] searches are restricted to evidence sources that have already undergone critical appraisal by others, such as evidence-based guidelines or evidence summaries". More recently, the 5S search strategy, which starts with the search of "summaries" (evidence-based textbooks) is a quicker approach. If the Users are the same as the "Receptives" in the study of Green, then this group may be 57% of physicians. Teaching this group management of information resources may be especially important.
For the "replicator", "decisions of respected opinion leaders are followed". This has been called "'borrowed' expertise". If the Replicators are the same as the "Traditionalists" and "Pragmatists" combined in the study of Green, then this group may be 40% of physicians. This is a very broad group of doctors. Possibly the lowest end of this group may be equivalent to the laggards of Rogers. This much smaller group of doctors, ones who have "severely diminished capacity for self-improvement", are cautious about change, and may be at increased risk of disciplinary action by medical boards.
Teaching evidence-based individual decision making
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