Evidence-based medicine for dermatologic surgeons: concepts in critical appraisal of information

The term evidence-based medicine (EBM) is increasingly being used. Physicians, journal editors, insurance companies, and patients are applying its tenets to clinical decision making. Although there are concerns about the overly zealous application of EBM to clinical situations, many of the basic concepts are important in improving decision making.

To define evidence-based medicine and to review potential problems in basing decision making entirely on less-than-ideal evidence.

We reviewed the EBM literature and looked for examples in dermatology of pitfalls in decision making based on poor evidence.

Following a definition of EBM, we review problems inherent in anecdotes and uncontrolled trials, including the placebo effect. Examples of medical practice that have been altered by doing more rigorous studies are provided.

Concepts of EBM as currently defined should be considered by dermatologic surgeons in assessing the available information for clinical decision making.