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March 10, 1993

Evidence-Based Medicine: A New Paradigm for the Patient

Author Affiliations

Reading, Pa

JAMA. 1993;269(10):1253. doi:10.1001/jama.1993.03500100051021

To the Editor.  —The Evidence-Based Medicine Working Group1 recently presented a clinical scenario of the treat/notreat decision in an adult with a first seizure. In this scenario, a resident's qualitative impression, that recurrent seizure risk is sufficient to justify therapy, is quantified before prescribing the therapy. The group suggests that "the way of the future," the "paradigm shift," "involves using the medical literature more effectively in guiding medical practice." I hope that they are correct.However, I would suggest that two additional major features could easily be incorporated into these authors' scenario. First, when appropriate data are gathered, these data should be summarized by the physician and presented to the patient. Each patient could then decide what course of action best suits his or her individual needs, risk tolerance, and so on. The patient is empowered; the locus of control shifts from physician to patient.Second, the relevant question