The EBM Process

The Patient	1. Start with the patient - a clinical question or problem arises from the care of the patient.
The Question	2. Construct a well-built question from the case.

EBM always begins and ends with the patient.
To begin this process, consider the following clinical scenario:

You are a physician in a large metropolitan hospital working in the emergency room. Your patient is, Laura, the 65 year old wife of a retired D.O., she has been hospitalized following a stroke. During physical examination, Laura says she is able to swallow easily. (She does not have dysphagia.) You find that she appears to be well nourished and does not seem to have trouble eating. Her husband believes that you should order a protein energy supplement for her. He says it is appropriate to order oral protein energy supplements for all hospitalized stroke patients because malnutrition is sometimes a problem in stroke patients and nutritional supplements may aid in reducing the risk of death or serious disability over a period of several months. Laura appears to be eating very well on her own and you wonder whether or not adding an oral protein energy supplement to Laura’s routine hospital diet will decrease her risk of death or serious disability over the next several months. You decide to research the answer and make a decision based on the best available evidence. You use a point-of-care database and make a treatment decision within minutes.

Laura

The next step in this process is to take the identified problem and construct a question that is relevant to the case and is phrased in such a way as to facilitate finding an answer.

We now go to Anatomy of a Question