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Use of Evidence in Acute Stroke Decision-Making: Implications for Evidence-Based Medicine
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  • Timothe Langlois-Therien,
  • Brian Dewar,
  • Ross Upshur,
  • Michel Shamy
Timothe Langlois-Therien
Ottawa Hospital Research Institute
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Brian Dewar
Ottawa Hospital Research Institute
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Ross Upshur
University of Toronto Dalla Lana School of Public Health
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Michel Shamy
Ottawa Hospital Research Institute
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Abstract

Evidence-Based Medicine proposes a prescriptive model of physician decision-making in which “best evidence” is used to guide best practice. And yet, proponents of EBM acknowledge that EBM fails to offer a systematic theory of physician decision-making. In this paper, we explore how physicians from the neurology and emergency medicine communities have responded to an evolving body of evidence surrounding the acute treatment of patients with ischemic stroke. Through analysis of this case study, we argue that EBM’s vision of evidence-based medical decision-making fails to appreciate a process that we have termed epistemic evaluation. Namely, physicians are required to interpret and apply any knowledge — even what EBM would term “best evidence” — in light of their own knowledge, background and experience. This is consequential for EBM as understanding what physicians do and why they do it would appear to be essential to achieving optimal practice in accordance with best evidence.

Peer review status:UNDER REVIEW

14 Apr 2021Submitted to Journal of Evaluation in Clinical Practice
16 Apr 2021Assigned to Editor
16 Apr 2021Submission Checks Completed
16 Apr 2021Reviewer(s) Assigned
06 May 2021Review(s) Completed, Editorial Evaluation Pending