Ways of using evidence-based medicine in general practice

General practitioners wanting to practise evidence-based medicine (EBM) are constrained by time factors and the great diversity of clinical problems t hey deal with. They need experience in knowing what questions to ask, in lo cating and evaluating the evidence, and in applying it. Conventional searching for the best evidence can be achieved in daily gener al practice. Sometimes the search can be performed during the consultation, but more often it can be done later and the patient can return for the "re sult". Case-based journal clubs provide a supportive environment for GPs to work t ogether to find the best evidence at regular meetings. An evidence-based literature search service is being piloted to enhance dec ision-making for individual patients. A central facility provides the searc h and interprets the evidence in relation to individual cases. A request fo rm and a "results" format make the service akin to pathology testing or ima ging. Using EBM in general practice appears feasible. Major difficulties still ex ist before it can be practised by all GPs, but it has the potential to chan ge the way doctors update their knowledge.