Evidence-based medicine in urology

Excerpt

Evidence-based medicine (EBM) is a term coined by Gordon Guyatt at McMaster University in 1991 referring to the use of the current best evidence from clinical research to the care of individual patients [1]. Its first guiding principle refers to a hierarchy of evidence; meaning that some evidence is more trustworthy than others [2]. The second, equally important principle of EBM relates to the need to integrate the current best evidence with an individual patient’s circumstances, values, and preferences. There is, therefore, no automatism from evidence, even if of high quality, to clinical action. A pragmatic and transparent approach, both rating the certainty of evidence and to moving from evidence to decisions has since been provided by the GRADE Working Group [3, 4]. The role of the empathetic expert clinician and urologic surgeon is, therefore, not under threat by EBM; it is his/her role to help the patient find the ‘best’ management approach [5]. …