Towards evidence-based medicine in surgical practice: Best BETs

Surgeons are faced with the dilemma that many clinical questions in their daily practice to do not have universally agreed answers, but patients increasingly demand the ‘best practice’ from their doctors. In addition time pressures mean that clinicians are unable to keep up with the full spectrum of published research. We have adopted an approach first pioneered in emergency medicine, namely the Best Evidence Topic or Best BET. Clinicians select a clinical scenario from their daily practice that highlights an area of controversy. From this, a three-part question is generated and this is used to search Medline and other appropriate databases for relevant papers. Once the relevant papers are found, these papers are critically appraised, the relevant data to answer the question is extracted, tabulated and summarised. A clinical bottom line is reached after this process. The resulting BETs, written by practising surgeons can then provide robust evidence-based answers to important clinical questions asked during our daily practice. ► There is a need for evidence-based practice in surgery. ► Best Bets provides a robust methodology for assessing best surgical practice. ► A clinical question is posed and the literature searched. ► The key results are summarised and tabulated. ► A clinical bottom line answering the clinical question is then made.