Evidence and primary care

Abstract

Primary care is the subject of more charters, declarations, manifestos, and principles than any other medical discipline, except perhaps its similarly plagued cousin, public health. Yet this efflux of ruminations from worthy experts and respected bureaucracies has contributed hardly anything to the daily practice of family medicine. Worse, while such theoretical self-absorption has been proceeding with gathering enthusiasm, primary care itself has lost its way, descending into a pit of management jargon and embarking on defensive fence building. One of the most pressing issues facing general practice today—the meaning of evidence—is often ignored. Application of evidence from randomised controlled trials to general practiceThe general practitioner who deals with at least 100 problems in 30 or more patients each day constantly provides simple advice—for example, to stop smoking, eat a low-fat diet, walk when experiencing acute low-back strain, or to take acetylsalicylic acid to prevent heart attack.1–4 Several questions emerge from this daily workload. Should all recommendations made by general practitioners be supported by high quality evidence from properly conducted randomised controlled trials (RCTs)? Should the RCT be the gold standard to determine whether advice is appropriate for patients or are other methods to substantiate evidence adequate? Is it appropriate to directly apply evidence derived from population-based RCTs to individual patients in general practice? Answers to these questions are required if so-called evidence-based medicine is to become standard medical practice and result in improved health status of populations worldwide. Full-Text PDF