Best Evidence Topics (BETs) Introduction
Medical practice has always been informed by many things: textbooks, personal experience (good and bad), scientific research, patient expectations, teaching from senior doctors, colleagues opinions, old wives' tales... the list goes on. Every clinical decision is based on a combination of these factors, acting to differing degrees upon the individual clinican. The trouble is, of course, that many of these sources of information are far from trustworthy. Many of the traditions within medicine, handed down through generations of doctors, are simply wrong, and many more miss the mark of the best practice. Personal experience can be helpful to clinicians, but it can also bias their judgements detrimentally. Our reading of the scientific literature, being necessarily limited by time, will tend to bias our knowledge.
Evidence Based Medicine (EBM) is an approach to medical decision making that acknowledges our need to be informed by a comprehensive summary of the best scientific evidence, appraised systematically and expertly, without bias. Factors such as experience, compassion and equity still factor in the decision making process, but EBM allows a reasonable degree of certainty that the scientific basis for decisions is as sound as possible. The Critically Appraised Topics (CATs) developed by Sackett in Oxford are well suited to their "home specialty" of general medicine, where evidence from large scale trials is generally readily available, and physicians have multiple contacts with each patient. Emergency Medicine, however, often sees problems dealt with very little by high quality research, and has single patient contact episodes.
BETs bring the evidence one step closer to the bedside, by providing answers to very specific clinical problems, using the best available evidence. Each Topic answers a carefully worded 3-part question, using a structured approach to finding and reviewing the literature. BETs are designed specifically for Emergency Medicine. The BET method allows the use of lower quality research, and lists the shortcomings of the evidence used. As with other forms of EBM topic review, each BET has a clinical "bottom line" for the busy physician.
Being brief and well-structured, BETs can be reviewed at regular intervals, to ensure the evidence remains the best available.