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Use of Evidence in Acute Stroke Decision-Making: Implications for Evidence-Based Medicine
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  • Timothe Langlois-Therien,
  • Brian Dewar,
  • Ross Upshur,
  • Michel Shamy
Timothe Langlois-Therien
Ottawa Hospital Research Institute

Corresponding Author:[email protected]

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Brian Dewar
Ottawa Hospital Research Institute
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Ross Upshur
University of Toronto Dalla Lana School of Public Health
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Michel Shamy
Ottawa Hospital Research Institute
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Abstract

Evidence-Based Medicine proposes a prescriptive model of physician decision-making in which “best evidence” is used to guide best practice. And yet, proponents of EBM acknowledge that EBM fails to offer a systematic theory of physician decision-making. In this paper, we explore how physicians from the neurology and emergency medicine communities have responded to an evolving body of evidence surrounding the acute treatment of patients with ischemic stroke. Through analysis of this case study, we argue that EBM’s vision of evidence-based medical decision-making fails to appreciate a process that we have termed epistemic evaluation. Namely, physicians are required to interpret and apply any knowledge — even what EBM would term “best evidence” — in light of their own knowledge, background and experience. This is consequential for EBM as understanding what physicians do and why they do it would appear to be essential to achieving optimal practice in accordance with best evidence.
14 Apr 2021Submitted to Journal of Evaluation in Clinical Practice
16 Apr 2021Submission Checks Completed
16 Apr 2021Assigned to Editor
16 Apr 2021Reviewer(s) Assigned
06 May 2021Review(s) Completed, Editorial Evaluation Pending
10 May 2021Editorial Decision: Revise Major
15 Jun 20211st Revision Received
19 Jun 2021Submission Checks Completed
19 Jun 2021Assigned to Editor
21 Jun 2021Review(s) Completed, Editorial Evaluation Pending
21 Jun 2021Editorial Decision: Accept
Oct 2022Published in Journal of Evaluation in Clinical Practice volume 28 issue 5 on pages 733-740. 10.1111/jep.13597