Evidence-based medicine and primary care: keeping up is hard to do

Primary-care physicians feel pressure to be knowledgeable, efficient, comprehensive, and compassionate while delivering evidence-based medical care. Incorporating evidence-based medicine into practice requires training in the skills of finding and applying good evidence to patients, and, increasingly, infrastructure that supports the incorporation of evidence into electronic health records. Physicians cite many barriers to the use of evidence-based medicine in practice. In this review, we examine evidence of the value of evidence-based medicine in clinical practice, discuss the interface of evidence and shared decision-making, suggest tools and approaches for incorporating evidence-based medicine into practice, and discuss the impact of recent health insurance reform on expectations and incentives for physicians with respect to evidence-based practice.