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Human Reproduction, Vol 12, 1847-1850, Copyright © 1997 by Oxford University Press

REVIEWS

Clinical research evidence and clinical practice

JA Collins
Department of Obstetrics and Gynecology, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.

An informal survey among colleagues turns up the far-from surprising information that the average patient contact involves at least three or four judgements and decisions: judgements about aetiology and prognosis, decisions about diagnosis and therapy, and sometimes discussions about costs and side-effects. And so it goes: 20 patients a day, 60 decisions; 100 patients a week, 300 decisions. Who makes these decisions, the doctor or the patient? What factors govern the final choice in each case? Evidence-based medicine (EBM) is the factor getting a lot of attention these days, but clinical decisions depend on many different elements. Good doctors have always made use of experience and judgement as well as the best available evidence.
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