Evidence-Based Medicine: Enabling Physicians to Make Better Decisions

  • Velma L. Payne
Part of the Health Informatics Series book series (HI)


There was a day when physicians, armed with a degree and a mission, had the confidence that based on their knowledge they could see patients, hear their complaints, and determine the best course of action to cure or ease their pain. Physicians were trusted and left to rely on their expertise to determine what was in the best interest of each patient. The medical profession, like every avenue of life, has gone and continues to go through a profound transition. The days when physicians were trusted to make the proper decision to heal the sick are gone. The basic assumption of the past, that what a physician decides by definition is correct, is being challenged. The root of the challenge is a concern for quality health care. According to David Eddy, “The plain fact is that many decisions made by physicians appear to be arbitrary—highly variable, with no obvious explanation. The very disturbing implication is that this arbitrariness represents, for at least some patients, suboptimal or even harmful care” [1]. Eddy states “substantial variations in what physicians see have been reported in virtually every aspect of the diagnostic process, from taking a history, to doing a physical examination, reading laboratory tests, performing a pathological diagnosis, and recommending a treatment” [1, p. 2]. These variations are centered on observations, perceptions, reasoning, conclusions, and practices [1, p. 2]. Statistics provided indicate that observers looking at the same thing will disagree with each other or even with themselves from 10 percent to 50 percent of the time [1, p. 2]. Eddy also feels that even though there is variability in medicine, it is not randomly practiced. Physician decisions might be variable, but they are not flippant or whimsical decisions. Variability in decisions occurs due to the complexity of problems occurring under difficult circumstances. Physicians are in the impossible position of not knowing outcomes of different actions, but having to act on them anyway. Physicians are in a position where they not only must deal with the mysteries of human biology and disease and continually expanding technologies, but a montage of other forces such as the expectations of patients and their families, personal, professional and financial goals, changing reimbursement systems, competition, malpractice, peer pressure, and politics, as well as incomplete information.


Clinical Expertise Future Technology Healthcare Industry Target Outcome Computerize Clinical Decision Support System 
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Copyright information

© Springer Science+Business Media New York 2004

Authors and Affiliations

  • Velma L. Payne
    • 1
  1. 1.LLCPittsburghUSA

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