Evidence-based surgery

• Main Author: Miran Rems
• Format: Article
• Language: English
• Published: Slovenian Medical Association 2007-04-01
• Series: Zdravniški Vestnik
• Subjects: evidence-based surgery; surgeon; critical assessment; ethics
• Online Access: http://vestnik.szd.si/index.php/ZdravVest/article/view/1706
• ISSN: 1318-0347; 1581-0224

<p><strong>Background:</strong> Surgery is setting a new ground by the reign of evidence that was brought up by the Evidence Based Medicine (EBM). While experiences and opinion of an expert count the least by the principles of EBM, randomized controlled trials (RCT) and other comparative studies have gained their importance. Recommendations that were included in guidelines represent a demanding shift in surgeon’s professional thinking. Their thinking and classical education have not yet been completely based on the results of such studies and are still very very much master-pupil centred. Assessment of someone’s own experiences is threatened by objectivity as negative experiences get recorded in deeper memory. Randomized studies and meta-analyses do appear also in surgery. However, they demand an extra knowledge about critical assessment.</p><p><strong>Conclusions:</strong> Setting a patient to the foreground brings a surgeon’s decision to the field of EBM. The process has already begun and cannot be avoided. Decision hierarchy moves from the experience field to the evidence territory but to a lesser extent when compared to the rest of medicine. There exist objective restrictions with approving a new paradigm. However, these should not stop the process of EBM implementation. Finally, there is an ethic issue to be considered. Too slow activities in research, education and critical assessment can bring the surgeon to the position when a well-informed patient loses his/her trust.</p>