Evidence does not make decisions, people do
- R Brian Haynes (firstname.lastname@example.org), professor of clinical epidemiology and medicine,
- P J Devereaux, clinical scholar,
- Gordon H Guyatt, professor of clinical epidemiology and medicine
- McMaster University Faculty of Health Sciences, 1200 Main St West, Hamilton, ON, L8N 3Z5, Canada
Acriticism directed at evidence based medicine is that it ties the hands of practitioners and robs patients of their personal choices in reaching a decision about optimal care.1 There are many barriers to implementing health research in practice,2–4 but, conceptually at least, tying clinical hands and robbing patients of their choices are not among them. Rather, patients' preferences were incorporated into the first model of evidence based medicine5 and their importance has been underscored in a recent revision, depicted in the figure.
In this figure, clinical decisions must include consideration of, firstly, the patient's clinical and physical circumstances to establish what is wrong and what treatment options are available. Secondly, the latter need to be …