The practice of Interventional Cardiovascular Medicine: "Evidence-based" or "Judgment-based"?

Evidence-based medicine has emerged in response to empiric clinical decision-making with the quest of infusing more "science" into the process of caring for the sick. Yet, evidence-based medicine today is being applied to clinical practice in a rigid and, paradoxically, unscientific manner. The perception that evidence-based medicine is the "ultimate and unquestionable biologic truth" that should supersede all other components of clinical decision-making at the individual patient level needs to be critically reexamined. The practice of Interventional Cardiovascular Medicine should represent a bottom-up approach that integrates the best external evidence-that has been critically analyzed-with individual clinical expertise and patient choice; it cannot result in cookbook approaches to patient care. External clinical evidence should inform, not replace, individual clinical expertise, and it is this expertise that decides whether the external evidence applies to the individual patient at all and, if so, how it should be integrated into a clinical decision.