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How can clinicians incorporate research advances into practice?

1997; Springer Science+Business Media; Volume: 12; Issue: S2 Linguagem: Inglês

10.1046/j.1525-1497.12.s2.3.x

1525-1497

Eric B. Larson,

Meta-analysis and systematic reviews

n 1965, my freshman college chemistry lab partner told me an anecdote about his father, a Michigan country doctor, that left an indelible impression. He contrasted the drudgery of a freshman struggling to master college chemistry with the excitement his father experienced at a medical education meeting. The excitement came from how much his dad had learned. He learned how to be a better doctor. He was going to change his practice, and his patients would be better off because of what he had learned. Although it was not apparent to me as a naive freshman, this anecdote is an example of applied learning—new knowledge and research incorporated into practice. More than 30 years later, the practicing physician has the same opportunity: to improve practice based on new knowledge. Today's practitioner has an array of diagnostic and therapeutic techniques that are quite different from those of my classmate's father. In addition, the material generated by today's global medical research enterprise is extensive and expanding rapidly. We continue to experience the same sense of excitement over opportunities to learn of advances that help our patients. We are also, however, probably more aware today of practices that were adapted, only later to be proved ineffective or even harmful.1,2 The challenges of incorporating research into practice involve several processes. First, the clinician needs to learn of the advance. Second, some judgment should be made about whether a research advance signals the need to make a change in practice. Third, the clinician must change practice, including perhaps learning new skills. Each of these processes is dynamic. One of the joys of practicing internal medicine is the constant interplay of forces old and new—knowledge, judgment, and experience with patients—that constitute everyday decision making and practice. This article describes the challenges clinicians face learning about medical advances and determining whether an advance is relevant to practice. Examples are provided from recent updates in general internal medicine. A common theme is the importance of consensus in sifting through the scientific literature and in the development of practice changes. Modest changes in therapeutic precision, once proved, tend to be easier to incorporate into practice, whereas more radical changes will require more evidence and greater consensus. As a consequence, I do not believe in rapidly incorporating new agents into practice if they are only slightly different from existing, effective alternatives.