The future of evidence-based medicine

Evidence-based medicine (EBM) stresses the examination of evidence from clinical research as an important basis for the practice of medicine. EBM is an approach that is intuitively reasonable, and is increasingly taught in medical schools and incorporated into practice. Although it is often not feasible for busy clinicians to find and appraise original research themselves, EBM is now frequently used to develop clinical practice guidelines. However, there are often 'grey areas' in the interpretation of the evidence, some of which are discussed in this paper. Clinical medicine can be complex, and EBM will never provide easy answers to difficult problems, which means that there will always be an art to clinical medicine. As well, EBM is practised in complex, semirational, constantly changing health care systems, which sometimes actually establish barriers to the incorporation of evidence into practice.