So if EBM means evidence based medicine what does OBM mean?
OBM = Ostrich-Based Medicine (substitute whatever you like for the last bit, be that medicine, healthcare, dentistry) where we ‘bury our heads in the sand’ to the consequence of our individual and collective actions.
No one individual can have enough personal knowledge and experience to constantly be giving the best advice to their patients and once we check our ego’s in at reception and admit that to our serves several things happen:
What we thought was best advice last year may not be anymore. Getting feedback in healthcare can take years before the consequences of our actions can be seen.
What we read, hear and see may not always be true.
As health-care professionals using a few basic research tools, we must question everything no matter how eminent the source. If someone says they have the evidence (politicians love to use the evidence word) we must have the courage to ask them to openly disclose it for critical appraisal. A lot of times their evidence is weak, second-hand or anecdotal.
EBM is about taking the ‘best available evidence’ not ignore everything except randomised controlled trails. Then taking into account our personal experience and skill sets apply that information to the situation in hand, this is the ‘black art’ as Dr Brian Goldman like to call it. Another thing to mention is that most published evidence is presented based on an average value for a group of people and we need to interpret that data and apply it to the individual.
Freakonomics on Bad Medicine
Here are the links to three great podcasts on evidence-based medicine.
Reading the comments section is quite interesting as it highlights a lot of the problems with evidence-based medicine (EBM). Once both the profession, industry, and patients become comfortable with the realities of uncertainty, feedback and our personal biases then understanding the philosophy behind EBM become clearer.