EBM in practice: internal medicine

Specialists in internal medicine have a strong research and evidence cultur e, and there is a large evidence base, particularly for diagnostic tests an d therapeutics. Deficiencies in evidence exist in the area of clinical diagnosis, including the sensitivity, specificity and positive and negative predictive values o f clinical signs. The practice of evidence-based medicine (EBM) by internal medicine speciali sts is hindered by lack of clinical information support systems for ongoing practice evaluation, benchmarking and improvement. Many internal medicine practitioners are moving towards the use of clinical practice guidelines to aid the EBM process. A greater acceptance of EBM processes, including evaluation and guidelines, and resolving issues of distrust of bureaucracies, practitioner protection and consumer privacy, would increase the use of EBM in internal medicine.