Myth-based medicine.

Abstract

Evidence was meant to deliver us from foolishness. The promoters of evidence-based medicine (EBM) assert, ‘Good doctors use both individual clinical expertise and the best available evidence, and that neither alone is enough.’1 This is to say they think good doctors need only expertise besides evidence. What though is this thing we call expertise? Surprisingly, an agreed definition of expertise in this context does not exist. One attempt to do so states, ‘Clinical expertise must encompass and balance the patient’s clinical state and circumstances, relevant research evidence, and the patient’s preferences and actions if a successful and satisfying result is to occur.’2 By this definition, a good doctor needs three things: an ability to judge the patient’s clinical state; an understanding …