Dr Krishna is Director of London IVF and Genetics Centre, a leading fertility clinic in Central London. She has extensive experience in managing both male and female fertility patients and has special interest in patients who respond poorly or experience repeated treatment failure. She is passionate about delivering patient centred care and using latest scientific developments and evidence in managing her patients to achieve their best possible chance of conceiving.
What is Evidence based medicine?
November 7th, 2017
There has been a lot of talk about evidence based medicine since the recent BBC panorama programme. It started a much needed discussion but, fell short of educating patients on what is clinical evidence. In science, every proposed idea or pioneering intervention is supported by scientific research before it can be used with patients.
The term ‘Evidence’ refers to research studies findings and conclusions. A good quality research study has a well-defined clinical question and should have a robust design. The term ‘design’ refers to the clear structural outline of how study will be conducted. It should have clear definition of who will be included and who will be excluded, how it will take care of potential bias, what data will be collected, how this will be analysed and what metrics are being measured. It can be retrospective, if it is analysing previously collected data or prospective and it collects data as study progresses. Some will blind few researchers to avoid bias and is called a blinded study. This can be at different levels. Some may choose subjects randomly and compare them with a control group, called a randomised controlled trial. Finally, some may report and analyse the data that is pulled from all the reported studies and this is called a review or meta-analyses. Each of these models have their own strengths, limitations and feasibility issues in different settings. For example, a randomised double blind controlled trial, may not be suitable for pioneering technology that is in early days. Similarly, if there are many reported studies for a particular problem, then a review or Meta analyses may be a good evidence to use.
As you can see - just outlining the basics is getting complicated, then imagine the enormity of the task to address every problem. In very simple terms, evidence based medicine involves applying the best available scientific evidence in context of each couple or patient. It is a dynamic process wherein both specialist and patient work in partnership in deriving the best solution for every set of unique circumstances. It starts with a thorough understanding of a couple’s clinical circumstances, wishes, beliefs and applying the best available research evidence within that context. Here, communication is key in simplifying this complex information and striking a healthy balance in informing patients but not causing anxiety. It is an ancient tool that uses complex scientific information and art of communication to meet individual couple’s needs.
About the author: London Fertility Expert, Ms Shipra Krishna, MD MRCOG
ANDREW COUTTS, MA (Ed), BA (Law),BSc (Econ) Hons
Andrew Coutts is a regular speaker, writer and commentator on fertility issues and has been involved in developing numerous patient engagement events throughout Europe.