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Are we going to change the way we practice medicine? There are two kinds of medical knowledge: one is impersonal and results from research based on scientific methodology and scientific reasoning; the other is personal and results from learning and apprenticeship with seniors and from individual experience. Evidence-based medicine (EBM) is a new approach to teaching the practice of medicine. Instead of using personal knowledge, intuition, unsystematic clinical experience, and pathophysiological reasoning, it stresses evidence from clinical research. With this new paradigm in mind, clinicians should regularly consult the original literature, critically appraise the methods and the results, and then apply to the patient the optimal knowledge they have at their disposal. This new approach to medicine is gaining worldwide adoption, even if it more or less strictly interpreted. In France, even the translation of the English word "evidence " is controversial. There are two different translations for EBM. The most common is "Medecine fondee sur les preuves", and the other is "Medecine factuelle". The French word "Preuves" is the literal translation of "evidence" Some people argue against this term because its meaning is ambiguous for two reasons: --it does not express the full meaning of the English word "evidence", --there is a fear that the epistemological significance of "preuves" could be misinterpreted, giving birth to legal quibbles. Some people prefer the term "meilleures donnees acquises de la science". Other problems are linguistic and organizational. How can a busy French-speaking practitioner locate, retrieve and critically appraisal original articles, most of which are in English, unless he/she has a library containing the combined international medical literature? French meta-analyses, systematic reviews and books dedicated to evidence-based subjects are alternative options. Even when these practical problems can be solved, the proper place of research-based evidence must be clarified. When evidence is lacking, practitioners have to rely on other forms of medical reasoning for their decisions. Moreover, decision-making is not automatic: in addition to taking scientific knowledge into consideration, each medical decision is the result of a series of judgments based on human and environmental factors. |
