Searching for evidence: don’t forget the foundations

Excerpt

Evidence-Based Medicine (EBM) is a modern approach for integrating current medical knowledge into clinical practice. It says that management of patients should be based on rigorous assessment of results of randomised controlled trials combined with evidence from other forms of research. This approach has merit. Variation in the management of patients can result in care of varying quality and varying mortality. Where certainties result from medical research, it is helpful to formulate rules from the research and then apply the rules in the care of patients. Managing patients on the basis of best available research data is hard to criticize, and physicians have followed this tenet for centuries. But we must be ever mindful that the certainty of today is more relative than we are inclined to think, and is unlikely to last forever. …