Tuesday, 13 January 2009

Accessing Evidence-Based Medicine

There is discussion in blogs at the moment about the limits of Evidence-based medicine and how it may be impacted by web2.0 technologies. Laikas, a Dutch librarian, posted about this recently. Sarah Stewart, a midwife from NZ, replied by describing some of the difficulties faced by the public in accessing EBM and the resulting asymmetry of information between doctors and patients.

This reminded me of a You-Tube video I came across last year.

It is an interview Muir Gray, the NHS Chief Knowledge Officer (a post he first floated in 1998 in the BMJ), describes his view of the future of information in the NHS. Resources will be equally available to patients, (or to use his term, citizens) and to professionals. As a clinician and citizen I think this is an enlightened policy. I find much of the content on the NHS choices website very exciting, including Behind the Headlines. BtH gives an evidence-based critique of health stories in the press. I do not like Map of Medicine..... but more about that later:)

To illustrate some of the different sources of EBM available I am going to look at guidance on the management of stable COPD (chronic obstructive pulmonary disease).

First of all here is the page from the BMJ's Clinical Evidence site. I find this very unhelpful. If I wanted to know about one particular treatment and the evidence base, or lack of, for it's use in the management of the condition, this would be useful. But it is not at all useful for a brief synopsis of how to manage the condition.

Next, Clinical Knowledge summaries COPD page. This has many different levels of information and takes quite a lot of clicking around. But it is likely to be useful to a clinician in a surgery. And probably to patients/citizens as well.

GP Notebook is in my experience a favourite of UK GPs. Looking at it's info on the management of stable COPD it is clear that the guidance is related to the NICE guideline on the topic because it references the NICE guidance, and describes different steps for mild/moderate and severe levels of disease. This looks the easiest to access and most clinically relevant so far.

Lastly, we have the Map of Medicine stable COPD page. This annoys me on many levels. For one we are told under 'indications for referral' that this should be considered for severe COPD, but you have to go down to 'follow-up care in severe disease' to find out what the criteria for diagnosing severe COPD is.

What do you use to access EBM? Are different sites useful for different purposes? I'd love to hear your thoughts.

EDIT 11/8/10 I've reviewed the Map of Medicine page (previous link had died- new one is current) and it still does not make diagnosis criteria clear, unfortunately. Time to drop them a tweet!


  1. What would you say is the best site about EBM for patients/citizens?

  2. Good question. I'm glad someone can make me focus! I think that the clinical knowledge summaries are good. I don't think that the Map of Medicine is. Looking at them, what do you think?

  3. Have never heard of it, so will have a look.

  4. Map of Medicine is one of those "tools" which is meant to make things easier but is actually rather confusing. From a process modelling point of view it doesn't adhere to any national standards and mixes lots of concepts together e.g. decisions, processes, inputs etc. Other things such as NICE Guidelines and National Service Frameworks useful at a medical professional level.

    For patients there is NHS Choices and NHS Direct and up-and-coming HealthSpace. The NHS National Library for Health http://www.library.nhs.uk/ helps in a way, but newer advances in NHS Evidence is promising http://www.library.nhs.uk/Cardiovascular/ViewResource.aspx?resID=290128. Bandolier is also another resource I know of http://www.medicine.ox.ac.uk/bandolier/.

    The UK Government is looking to amalgamate these portals much like DirectGov and BusinessLink do to make it more accessible to the public.

    I agree there should be some form of amalgamation of these services, or at least a number listed to choose from. I think the goal of the Department of Health legislation is just that, ease of use and quality. How long that will take is anybody's guess!

  5. Hi Mark
    Thanks for checking in.
    CKS is from National Library, and very good. I have no idea what NHS evidence will look like but hope it's good.
    I love the style of Bandolier. It has a great 'voice'. Unfortunately it must be under-funded as updated slowly.
    We haven't mentioned TripDatabase yet which is SUPER for looking for info on a specific topic. But here I was trying to think what is the best way of accessing guidelines when you know they exist.

  6. In Scotland we have access to the Scottish NHS's "elibrary" http://www.elib.scot.nhs.uk/portal/elib/pages/index.aspx
    It's my first port of call for such queries. Just last year they introduced tagging to encourage a social networking element and help you to find what others have found, but, like all tagging systems, you have to have enough people doing enough tagging to make it worthwhile! (and it's not really achieved that yet)


  7. If EBM is to be designed to be used by "citizens" then we need look through their eyes to understand what they need and how to construct the information in way that they can understand and action it if necessary. I think NHS Choices and netdoctor do this quite well. If however the audience is a GP then the needs may well be different and the level of understanding greater.
    So basically a one size “Fits and meets all” approach is a poor deliverable, especially when in today’s online world we have the capability of profiling and segmenting customers based on their needs. To this day i still have not seen a joined up and coherent online strategy from the NHS that truly fosters the sharing of best practice.

  8. Thanks @klynn. This was written in Jan 09 and I'm not sure how much has changed since then. I know that NICE are planning revisions to their website. Watch this space!

    By the way, I don't think you'll see a coherent strategy from 'the NHS' as my sense is that it is to become a thing of the past.


I am reintroducing word verification to cut back on spam posts. I'm sorry if you find it frustrating,