Evidence-based medicine: a new ritual in medical teaching

Western medicine is a diverse social and cultural system which responds in different ways to internal and external pressures. The Evidence-Based Medicine (EBM) movement has, despite some resistance from the rofession, led to the introduction of EBM into many areas of medicine, including medical training. Using material from teaching sessions for junior psychiatrists in England, I argue that EBM's novelty and potential challenge to established medical practice has been absorbed and accommodated within ordinary professional life by ritualizing EBM teaching in the familiar form of a traditional teaching ward round, with the difference that a published paper is 'presented' rather than a patient. These ritual occasions have the further effects of preventing any debate about EBM (partly because of the lack of immediate clinical application) and of limiting thought outside the paradigm of EBM and, indeed, of Western medicine itself.