The essence of EBM

Practising what we teach remains a big challenge

Two roads diverged in a yellow wood, And sorry I could not travel both.…

Robert Frost

When Frost pondered these two roads, he did not call for a randomised controlled trial. Life is about chance, and that goes for medicine too. Clinicians know that sometimes the best we can do is make our decision, hope it will have made all the difference, and not pine away about the road not taken. Today, as medicine lurches down the road to an evidence based world view, do we know where we are going? Should we turn back?

Even well intentioned supporters ask what's the “E” for evidence based medicine (EBM)?1 Its most basic assumptions are unproved, indeed largely untested. For example, we do not know whether “convincing information leads to optimal decision making.”2 Nor do we know whether most healthcare professionals “base their decisions on the best evidence.” As Frost wrote about another wood, EBM has miles to go, and promises to keep.

One problem is the lack of consensus and clarity about what EBM is. Experts have explained well what EBM is not.3 It is not a clearing house for cookbooks. Nor is it something we have been doing all along, repackaged to …