Looking beyond your own office, you’ll find a trove of evidence-based tools and resources through the Internet. Some are more useful than others; the trick is to know where to go so you quickly get good information you can trust. You might use Google, and that can be OK, as long as you know how to critically appraise the research studies you unearth. That takes time, of course. Medically focused Web crawlers, such as PubMed or SearchMedica (a portal that can be accessed through PhysiciansPractice.com, and whose owner, CMPMedica, is Physicians Practice’s corporate parent) will trim out much of the schlock for you.

But you can also find dedicated, Web-based tools to keep you evidence-based. Following are a few biggies often cited by physicians as their go-to sites for evidence:

• UpToDate — Contains more than 76,000 pages of text, graphics, a drug database, and links to outside study abstracts. About 3,800 physicians from 18 specialties monitor 400 journals, critically appraise the study results contained therein, and incorporate the best information into UpToDate three times a year. This makes it more than simply a “journal watch,” as the actual content of a new study is considered critically. It costs about $500 a year, give or take, with many caveats and subscription types available. Ott has decided that, for her, despite it being “a little pricey,” she considers UpToDate superior to purchasing updated text books.
  
  
• The Cochrane Collaboration — Offering some free access, the Cochrane Collaboration is very clear about avoiding what it calls “conflicted funding,” that is, funding from for-profit industries such as pharmaceutical or medical device companies. Within the collaboration’s library, you can search the “Cochrane Database of Systematic Reviews” for analyses of healthcare interventions. This organization also pulls in studies written in foreign languages.
  
  Full access to the Cochrane Collaboration will cost you about the same as UpToDate. All of its review abstracts, however, are free. One great feature of the reviews: They contain a plain-language “translation” that you can use to help explain the efficacy of a treatment (or lack thereof). Do you have a patient who fervently believes in taking only Vitamin C for a cold? Show her the evidence-based review in the Cochrane Library that concludes, through exhaustive research, an analysis of all available data on that subject: that unless she’s a marathon runner or an alpine skier, Vitamin C will do little to staunch her runny nose.
  
  
• eMedicine — Want to pay zero? eMedicine may work for you, but this WebMD-owned site does accept advertising. It does claim to be peer-reviewed; you’ll have to decide for yourself how to judge clinical studies that have been funded by the for-profit industry, such as pharmaceutical companies.
  
  
• ACP Journal Club — American College of Physicians members have access to this service. You’ll find a decade’s worth of archived articles here, with obsolete material constantly weeded out. Content comes from about 100 clinical journals, with articles going through a stringent criteria acid test.
  
  
• McMaster University — Ground Zero for evidence-based medicine methodology, McMaster’s Health Information Research Unit spends a great deal of time researching and forwarding the subject. Experts there also vet articles in support of the ACP Journal Club. You’ll find a wealth of evidence-based medicine links on the McMaster University Web site, through the Evidence-based Practice Center Web page.

Again, that’s a tiny sample of what’s out there. Note that many products you’ll find on the Web, such as UpToDate and PubMed, are downloadable to your PDA or iPhone, too. For a good list of other evidence-based medicine links and tools, visit McMaster’s Evidence-based Practice Center, and then click on “Partners/Links.”

Evidence-Based Medicine Elsewhere Evidence-based medicine has crept beyond the physician office, too. One area is with payers’ pay-for-performance programs, or “P4P,” which require you to follow certain guidelines they claim are evidence-based to get paid. Payers purportedly use guidelines so they know what and how much to pay for a treatment, and their P4P programs drive their performance metrics and incentives. This causes a fair amount of consternation among physicians. But is it well-founded? Goldszer thinks maybe not. Or at least it’s misplaced. “A lot of physicians worry about how they’re being graded, why they’re graded, who’s grading them. … There’s a lot of that consternation out there, absolutely. When you take a big picture look at it, it’s probably not that bad. You look at thousands of patients, and this is what should be done with thousands of patients,” he says. “It may be that the payers and the government are right, and we should have a little less consternation.” Haynes essentially agrees with Goldszer. “Payers naturally have concerns about costs. They have to rationalize their costs across all the types of the things they’re asked to do. They have to make decisions about what they’re going to pay for,” he says. “One of the ways that evidence-based medicine can be useful is to make sure you get good value for the money.” A new treatment might be too expensive to be cost-effective, notes Haynes. The principle behind P4P programs is also logical: They are intended to encourage a more complete standard of care. That’s a good thing, says Haynes, but he acknowledges that in reality, “there are payers who will use an evidence-based argument to deny services. Payers can say, ‘I’m not paying for that service because you can’t show me the evidence it’s beneficial.’ But … a lot of patient situations where the situation is more complicated than the evidence can conform to. There’s not much allowance for those cases, and you spend too much time justifying why, in this particular patient, you didn’t use the evidence. That actually gets to the point that it’s detracting from your ability to see other patients. … Rather obnoxious approaches are being taken, even when it’s the ‘right’ thing to do.”

The heart of the matter

By now, the evidence-based medicine ball is rolling downhill, gaining momentum in the medical world. “I’m a big believer in evidence-based, standardized medicine,” says Goldszer. “But it’s variable. Hopefully, some younger physicians coming out are more amenable to using guidelines. I think some of the older are more resistant.”

Is such resistance futile? No, just fairly irrelevant. There’s simply too much important data that physicians need to know, says Haynes. “There’s such wide acceptance now that we have to pay attention to evidence or research. How we do that or when we do that — both are debatable issues.”