The health reforms in Britain during the 1990s have brought with them a profusion of buzz words and ideas-from the "purchaser-provider split" to the "primary care led NHS." The most challenging innovation, however, is presented by the concept of evidence based medicine. The first forgivable response of any doctor to this seeming jargon is likely to be "Well, of course that's what I always do," but these words may well be accompanied by a glazed, if not shifty, look in the eyes. The second response, perhaps more thoughtful and certainly more honest, will be a degree of confusion: "What does it really mean? How does one actually do evidence based medicine? Surely there is not enough time? What kind of doctor am I if my medicine is not evidence based?"
This quartet of authors, all world enthusiasts of evidence based medicine, assume the medical equivalent of the United States Fifth Cavalry in the old westerns-coming to relieve the beleaguered garrisons of doctors in all tiers of health services. They make the purpose of their book very clear: "This book is written for clinicians at any stage of their training or career who want to learn and teach evidence-based medicine. Written for the busy practitioner, it is short, lean and highly practical." The presentation of the book, robustly covered in plastic and sized for the bulging white coat pocket, emanates this practicality and appeals at once because of it.
First, the concept of evidence based medicine is clearly defined-the integration of "individual clinical expertise with the best available clinical evidence from systematic research." Then, the format follows an unvarying structure through its five considerable chapters-which cover asking answerable questions, searching for the best evidence, critically appraising the evidence, applying the evidence to individual patient care, and evaluating the process. Each of these is stylised and iconised into sections on diagnosis, prognosis, best treatment, harm, and highest quality care with a rather relentless parade of summary tables, usually in the form of questions that busy doctors should ask themselves.
In reading this book, I found a series of emotional responses not floating but rushing through my mind. First, gratitude that a confusing buzz word had been clearly explained and an agenda for action set out. I became impressed, then awed, then daunted by its enormity. Humour and jocularity broke through in places, sometimes a relief and sometimes jarring, and sometimes the overtly American behaviours expected (time outs, time ins, but no group hugs) distanced me from the task in hand. I am lucky, I am not yet a total cynic about health care reforms, but I felt rather mauled by this book. All you need to practice and teach evidence based medicine is in this book (except for the second 24 hours in every day). It positively explodes from each and every page, but I should have liked more understanding of my busy life in practice. It is a guidebook to the summits of evidence based medicine and quickly leaves the foothills. Read it on some of your good days, but keep the very best days to put it into practice.
KEVIN JONES,
senior lecturer in primary health care,
University of Newcastle upon Tyne
This book is available through the BMJ Bookshop to BMA members at the specially discounted price of £12.99.
