【正文】 d patientchoice in a bottomup approach. – External clinical evidence can inform, but can never replace, individual clinical expertise. ? EBM is not costcutting medicine – when efficacy for the patient is paramount, costs may rise, not fall What EBM is Not ? EBM is not restricted to randomised trials – The randomised trial and systematic review are the “gold standard” for judging whether a treatment does more good than harm. – However, some questions about therapy do not require randomised trials or cannot wait for the trials to be conducted. – Sometimes the evidence we need will e from the basic sciences such as geics or immunology. – And if no randomised trial has been carried out for our patient’s predicament, we follow the trail to the next best external evidence and work from there. 。 ? 2022年 – 國家藥品監(jiān)督管理局（ SDA）批準(zhǔn)中華靈芝寶轉(zhuǎn)為“國藥準(zhǔn)字” B20220428，并更名為“雙靈固本散”。 – 中國科學(xué)院上海藥物研究所完成“‘中華靈芝寶’對多種培養(yǎng)人癌細(xì)胞生長的作用”。 Jarvik, Radiology 2022。 hour – More diasgnostic tools, more drugs, more treatment methods – “Half of what you are taught as medical students will in 10 years have been shown to be wrong. And the trouble is, non of your teachers knows which half.” ? Increasing medical costs ? The patient knows more, and questions more! Background ? Too little time – To keep up to date in Internal Medicine, I need to read 17 articles a day, 365 days a year Background ? False evidence ? Anesthesia and Analgesia – 2022 IF – 2022 Total Cites 15960 Definition ? Evidence Based Medicine – is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. – Sackett, D. L. BMJ 1996 – Evidencebased medicine is the integration of best research evidence with clinical expertise and patient values – Sackett, D. L.