Dr. Rajiv Lochan, Lead Consultant – HPB, Liver Transplantation, and Robotic Surgery, Manipal Hospital Old Airport Road.

Evidence-based medicine is the systematic, scientific, and explicit use of currently available best evidence in making clinical decisions for patients, resulting in better outcomes. This concept was introduced into medical literature only in the 1990s by Professor Archibald Cochrane who started a movement that strongly recommended that patient care should be based not on the individual beliefs of a doctor (his “experience”), but on objective evidence.

Now, What is Objective Evidence?

In the current scenario, five levels of evidence are used in medical care – from level 1 to level 5. Level 1 is individual case reports, patient studies, or a particular doctor’s belief based on his or her own knowledge and experience – this is marked as the lowest form of evidence. On the other hand, level 5 evidence is the collation of randomized trials that have been performed, evaluating a particular investigation, treatment, or test – this forms the highest form of evidence.

This whole concept has brought on a specialized field – a scientific discipline that has arisen not only to create evidence-based knowledge, but also to formulate guidelines, scales, and scoring systems to interpret and stratify all the clinical and scientific evidence that is constantly being published.

Evidence-Based Medicine and Clinical Governance:

This concept of evidence-based medicine in healthcare is a vital component of clinical governance, a concept that was introduced into the healthcare practice around the same time as evidence-based medicine. Clinical governance aims to deliver the highest quality of patient care in any particular situation, considering available resources, taking into consideration accountability, and emphasizing continuous improvement within healthcare organizations, ultimately leading to better patient outcomes and experiences.

Role of Evidence-based Medicine in Medical Practice:

This vast body of evidence has been collated for the past 30-odd years, making it a primary responsibility of every clinician to be abreast of the whole literature. This will help them provide patients and their families with informed recommendations for the best possible tests, investigations, or management options for their particular situation.

We often notice that the clinician’s recommendations are tempered by his or her own expertise and are centered on the expectations of the patient and their family. This is foremost as we all are aware that the decision-making process in healthcare is inherently complex in all aspects of human life. Thus, navigating this complexity with care remains the primary goal of counseling when patients visit our outpatient clinics.

Does AI Have An Impact On Evidence-Based Medicine?

In the digital age, the use of artificial intelligence (AI) is revolutionizing all aspects of our lives, thus it is not surprising to see AI making a big impact on EBM or evidence-based medicine. AI is leveraging vast amounts of clinical data to develop easily understandable clinical decision-making algorithms. These AI algorithms can analyze large data sets of patient records and clinical trials to identify evidence and trends very easily. Soon, AI-powered clinical decision support systems are believed to have the potential to help and confirm clinicians that their decisions are in the best interest of the patient.

There is a significant push for AI-supported personalized medicine and risk prediction in evidence-based medicine. However, current AI-based systems lack integration of patient preferences and the clinician’s expertise which help in a clinical decision – which are the key components of any investigative or treatment pathway. Nevertheless, this area is rapidly evolving and will undoubtedly continue to play a big role in improving healthcare delivery and patient outcomes in the future, not just individually but also across the community.