Evidence base: rock of certainty or shifting sands?

Editor—In his personal view Dewhurst discussed his problems with evidence based medicine.¹ I spend most of each day accessing, appraising, and synthesising research evidence to answer a range of clinical questions, but no one would suggest that—lacking, as I am, in both a medical degree and clinical experience—I should undertake to treat patients based on the information I collect.

Evidence based practice is not practice directed by research evidence. Evidence based practice is the judicious use of research evidence, based on a clinician's expertise and experience, in light of the patient's preferences. Research evidence does not supersede the challenging role of the doctor in clinical decision making, but it can support it. Just as diagnostic tests provide additional, helpful information but don't dictate patient management, research evidence provides further, hopefully useful information, but can't and shouldn't dictate practice. As both a patient and an evidence based practice researcher, I fervently hope that doctors still observe and think.