Seven alternatives to evidence based medicineBMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7225.1618 (Published 18 December 1999) Cite this as: BMJ 1999;319:1618
- David Isaacs, clinical professor (firstname.lastname@example.org),
- Dominic Fitzgerald, staff physician
- Departments of Education and Medicine, New Children's Hospital, Westmead, NSW 2145, Australia
- Correspondence to: D Isaacs
Clinical decisions should, as far as possible, be evidence based. So runs the current clinical dogma. 1 2 We are urged to lump all the relevant randomised controlled trials into one giant meta-analysis and come out with a combined odds ratio for all decisions. Physicians, surgeons, nurses are doing it3–5; soon even the lawyers will be using evidence based practice.6 But what if there is no evidence on which to base a clinical decision?
Participants, methods, and results
We, two humble clinicians ever ready for advice and guidance, asked our colleagues what they would …