1 Evidence-based obstetrics and gynaecology

‘At present, many clinical decisions are based principally on values and resources—opinion-based decision making; little attention has been given or is paid to evidence derived from research—the scientific factor’ (Gray, in press). Our ultimate aim is to ensure the practice of effective medicine in which, quite simply, the benefits to an individual patient or population outweigh any associated harm to that same patient or population. To do this, we need the skills to produce and evaluate the evidence on which our decisions are based. Evidence-based practice can help us to incorporate those skills into our working day. It depends on good clinical skills, forming a concise relevant question, becoming efficient in searching for the information, appraising that information, implementing the information into our daily practice and, finally, closing the circle by auditing our efforts at implementation and the effects within our own practice population.

There seems no doubt that our patient care should be rooted in the best external evidence. Despite obstetricians, in particular, already having a great deal of information critically appraised and summarized for them, our clinical practice risks becoming out of date because of a propensity to lag behind the evidence as it stands, whether in discarding the ineffective or in introducing effective care policies.

We need the techniques of evidence-based medicine to equip us as self-directed learners in our quest to remain well-informed practitioners. We owe it to our patients to ensure that, in consultation with them, we are doing the right thing for them.