Die Evidenzbasierte Medizin: gescheitert oder einfach nur anders?

Evidence-based Medicine (EbM) has been identified with the “Five Steps” of asking an answerable question, tracking down the evidence, appraising original articles, integrating the result into one's practice and evaluating the effect. However, the constraints of most health care settings allow the full cycle of this approach to a very limited number of problems only. Most problems have to be solved at the intuitive end of the cognitive spectrum. But even for everyday routine, the logic of EbM helps practitioners to reflect on their practice, to ask and follow-up on their questions. Doctors achieve this in a variety of ways; Sackett's Five Steps is only one of them. We conclude that EbM has had a tremendous impact on practitioners in this country. Future training efforts have to be adapted to the cognitive structure of doctors' reasoning.