A weight of evidence | |
Clinical evidence. A compendium of the best available evidence for effective health care. 5th edition. London: BMJ Publishing, 2001 (xxiii + 1432 pp + CDROM(personal) (institutional)). ISBN 0 7279 1612 2.
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Being asked to review Clinical evidence is a bit like being asked to review the Bible — the previous edition is on the desk of about 600,000 people around the world; I expect thunderbolts from the high priests of evidence-based medicine if I criticise it; and, at 2.6 kilos, it weighs about as much as the average tablet of stone.
It certainly meets its stated aim of summarising the current state of knowledge and uncertainty about the prevention and treatment of clinical conditions, but I would use it more frequently if it were more portable. That is the major problem with this book — it is not yet available in a pocket-sized version (either for Palm or paper). Such a concise version with “smart” summaries will be piloted in the next edition, and specialist versions are planned to cater for the exotic tastes of single-organ doctors. In the meantime, carrying it around helps to protect my aging bones against osteoporosis (one of the topics not yet covered). The availability of evidence at the bedside is an important factor in determining whether it is used to support daily decision-making about patient care. Clinical evidence, while useful to consult in a contemplative fashion when reviewing cases, has not yet become as essential to me as the stethoscope. The on-line and (new to this edition) CD-ROM versions do increase the number of points in the hospital system where it can be accessed, but most Australian public hospitals do not yet have enough point-of-care terminals for these formats to have a huge impact. Few general practitioners would have time to refer to it during the average short consultation either. The CD-ROM is fast and reasonably intuitive to use. The ubiquitous Microsoft Internet Explorer platform means that embedded links to abstracts of original articles are available via PubMed if you are using a computer with an Internet link. The glossary is also helpful. These variations in packaging may increase sales, but I feel obliged to point out that the hope expressed in the introduction, that Clinical evidence will improve patient care, has yet to be demonstrated in a randomised controlled trial. Perhaps Australia’s contribution to evidence-based medicine could be to demonstrate that a resource ranked by doctors in their top three favourite sources of information improves the care we deliver. Julia M Lowe
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