Epistemology of evidence based medicine

Clinically relevant attitudes and guidelines issued by a rational evidence based medicine (EBM) approach integrate individual clinical expertise with the best available external clinical evidence from systematic research. However, many physicians, while considering the ultraliberal world they are practising in and fearing that the primary goal of managed care in a market environment is reducing cost in order to make profit or decrease spending, remain suspicious of this kind of tentative protocol driven medicine when applied to medical and surgical practice. If physicians want to develop a health policy agenda that emphasises patient care issues above providers' or payers' interests, they should share a common semantics (i.e. understand the words and the numbers), enhance education programmes, improve continuing objective assessment of the way medicine and surgery are performed, face moral issues raised by innovation, and assume an increased leadership role in sound critical evaluation of non-validated new techniques. They should no longer consider EBM as a weapon turned against the medical profession, but rather see it as a tool that may provide some answers to chronically unresolved questions in the evolving art of Medicine and Surgery.