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Evidence-Based Medicine: A New Paradigm for the Patient-Reply FREE

Gordon Guyatt, MD
JAMA. 1993;269(10):1254-1254. doi:10.1001/jama.1993.03500100051023
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In Reply.  —We thank our correspondents for providing us with the opportunity to reemphasize several key points in our article.Dr Fox has supplied a thoughtful answer to a question that the scenario never asked. While Dr Fox raised the issue of therapy (in which the elements of net costs and benefits and patient utilities are key, as we and others have stressed elsewhere1), our scenario focused on the issue of prognosis. This emphasizes one of the important skills that evidence-based teachers must encourage: the careful definition of the question.We concur with Dr Fox's philosophical approach to practice that encourages patient empowerment. There is evidence to suggest that patients are better if they are empowered,2 though the matter warrants further study.Since several of the authors of our article previously have identified themselves as nominalists,1 readers will quickly grasp why we do not accept the narrow,

REFERENCES

Sackett DL, Haynes RB, Guyatt GH, Tugwell P. Clinical Epidemiology: A Basic Science for Clinical Medicine . Boston, Mass: Little Brown & Co Inc; 1991;.
Greenfield S, Kaplan S, Ware JE Jr.  Expanding patient involvement in care: effects on patient outcomes. Ann Intern Med . 1985;;102:520-528.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

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Sackett DL, Haynes RB, Guyatt GH, Tugwell P. Clinical Epidemiology: A Basic Science for Clinical Medicine . Boston, Mass: Little Brown & Co Inc; 1991;.
Greenfield S, Kaplan S, Ware JE Jr.  Expanding patient involvement in care: effects on patient outcomes. Ann Intern Med . 1985;;102:520-528.
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