Evidence- Based Medicine (EBM)

“Residents’ encounters with EBM show that pure ‘informal experience’ and ‘formal evidence’ do not really exist. Any consultation of written research is already prestructured by the overall diagnostic or treatment goal and informed by other research and accumulated clinical observations. Similarly, any experience is grounded in the hierarchy of written research evidence, anecdotes, consensus, and hunches of generations of clinicians and basic researchers. ‘Evidence’ and ‘experience’ constitute complementary resources that help residents in learning treatment options and patient management. . . . The quality that guides clinical decision making is not the tradition-bound experience put up as a straw person in the medical and sociological literature, but a mixture of skills and uncertainties grounded in medical knowledge. Medical knowledge acquisition can thus not be reduced to either evidence or experience but inevitably contains a mixture of the two, albeit not necessarily in equal proportions. . . . The proposed problem for which EBM is the solution does not match the reality of learning to doctor. Residents generally do not agonize as much about variability or dehumanizing care as they worry about getting through the residency without killing patients, completely exhausting themselves, accumulating negative evaluations, or getting sued” (Timmermans & Berg, 163-165).