Criticisms of EBP

Earlier in this chapter, we noted that some clinicians have felt EBP had the potential to erode their clinical autonomy and judgement, but that this has never been the intention. Rather, EBP is intended to enhance that judgement. Clinicians have often voiced a related criticism – that EBP is not patient-centred, because it relies on the general applicability of treatments, rather than tailoring interventions to individual client problems. We hope that our outline and example of the application of EBP has to some extent disarmed that criticism. Our own belief is that the application of tried and tested treatments is one of the most patient-centred things a clinician can do. Certainly, applying treatments which do not have an adequate evidence base must be the least, because, without knowledge of evidence, the clinician cannot give an adequate rationale for treatment to the patient, and without that rationale, the patient cannot make an informed choice. We regard adequate evidence as a prerequisite for patient-centredness.

Other common criticisms of EBP include the notion that it is a cost-cutting or treatment rationing exercise. EBP is certainly concerned with cost effectiveness, but this is not the same as cost-cutting. The rationale behind cost-effective treatment is that the pool of money will always be finite, and for every treatment you perform you lose the opportunity to perform another. Thus, it is important to choose the one with the best evidence behind it, including evidence of cost effectiveness. As with any effective approach, EBP, can be misused, and institutions may choose to do so. However, with EBP the decisions taken are more transparent and, therefore, more open to question by vigilant clinicians and patients.

Finally, it has been suggested that EBP is restricted to the use of randomised controlled trials. However, this is not so. EBP often makes extensive use of these studies for the reasons we touched on above, primarily because these studies are best at demonstrating the effectiveness of clinical interventions. Nevertheless, the entire range of research studies is considered in EBP, including non-experimental studies and qualitative research. The only criterion is that the evidence generated by a study is sufficiently methodologically robust to allow the study’s use in guiding care.

Indeed, this is perhaps the best way to think of EBP, as an educational process to assist and guide the HCP care rather than determine it.

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