循证医学的辩证思维

随着临床医学的发展，临床医生面临着从理论知识加个人经验的医学模式向以科学证据为基础的医学模式转变。越来越多的卫生政策和诊疗指南的制定需要以高质量的研究结果为依据，如随机对照研究的结果，特别是随机对照研究的系统综述结论。循证医学模式要求医生在临床工作中不断提出问题并通过严格的科研设计来回答这些问题，同时强调不断进行知识更新，掌握最新研究证据以指导其临床工作。同时政府部门也鼓励发展循证医疗，因为它可通过研究有效的诊疗手段来提高卫生保健的效率。此外还有迹象表明法律决策过程中要参考是否遵循了研究证据和临床指南。知情的服务对象也促使临床工作者寻求研究证据作为依据，为了提高服务质量并且充分把握特殊专业领域的现状，临床工作者也需要不断了解新的依据信息。在众多的研究信息中，我们应对每项证据的研究方法、研究对象及观察的终点进行认真分析，确定该结论是否真实并适合我们的实际，从而制定有据可查的诊疗方案。

Evidence Based Medicine and Dialectical Thinking

With the development of clinical medicine,clinicians are facing the transformation of medical model from theoretical knowledge and individual experience based medicine to scientific evidence based medicine.There is increasing pressure on health care professionals to ensure that the health policy and practical guidelines are made on the basis of available good quality research.Model of evidence based medicine was proposed with the requirement that doctors raise questions and try to find the solution by well designed study and the emphasis that clinicians refresh their knowledge and grasp the updated evidence to guide their clinical work.Many government are also encouraging the development of evidence based medicine because its advantages are understood,especially in terms of improved efficiency in the delivery of health care through the identification of effective treatments.In the presence of large number of research results which may not be consistent,clinicians will be needed to be able to access valid information by examining the method,subjects and end points of resource studies.