Pragmatic versus evidence-based medicine-it is not either-or

Pragmatism in medicine remains largely unacknowledged, undefined and un-described. We argue that it should not be viewed as an antithesis to an evidence-based approach, but rather as a way of solving a clinical problem whilst acknowledging limitations arising from the context in which the care is provided. The imperfection of the approach may be its strength, as uncertainty demands continuous re-appraisal of the situation. Existence of readily available evidence, compiled in a guideline may be an advantage, but is not a prerequisite for success. Indeed, the evidence-based approach is not perfect, and its application meets a number of limitations. We would like to assert that a pragmatic approach focused on seeking the most available, given therapeutic context, solutions remains the most available and efficient in present-day medical practice. It fills many holes between the academic perfection of research and vast heterogeneity of individual patients and clinical contexts.