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Evidence-based medicine: Fisher, Bayes, and medical education in the Czech Republic

Publication at First Faculty of Medicine |
2020

Abstract

From the physician's point of view, the evidence-based medicine is a tool supporting clinical decision based on the formal analysis of previously published evidence. There are two main approaches to summarize the evidence, the Fisherian or frequentist one and the Bayesian one.

Both approaches have not only advantages but also disadvantages and, thus, understanding of the principle is essential for successful facing the pitfalls. Unfortunately, medical education in the Czech Republic is relatively conservative, evidence-based medicine has not yet found a proper site in the curriculum.

For this reason, some misconceptions springing from unrecognized pitfalls of the evidence-based medicine are common among physicians. Although bizarre misconceptions like "I have some study telling it, therefore I'm right" are probably rare, some physicians may fall into troubles outside the comfort zone bordered by the strong meta-analyses and evidence-based clinical guidelines.

I will show examples of common misconceptions of different severity. Obvious pathological examples will be from the archive of the Czech Skeptics' Club Sisyfos, milder examples will be based on the questionnaire sent to young doctors.

As other tools, also the evidence-based medicine can be useful only if it is used properly. Improper use can be harmful for patients, therefore attention should be paid also to the insight-based education of physicians.