Looking for rules in a world of exceptions: reflections on evidence-based practice

Perspect Biol Med. Autumn 2005;48(4):477-89. doi: 10.1353/pbm.2005.0098.


After more than a decade, evidence-based medicine (EBM) is well established as an important influence in health care. EBM has engendered a wide range of responses from near-evangelical fervor to angered rejection, with supporters convinced of its scientific superiority and detractors of its needless reductionism. EBM is not a philosophical doctrine, and its originators and proponents have, for the most part, ignored critics and foresworn theorizing. However, EBM claims to be a normative guide to being a better physician. The theoretical, practical, and philosophical dimensions of EBM are intimately intertwined. This essay is a sustained reflection on the issues raised by EBM as experienced by a clinician/teacher who has tried to apply the tenets of EBM in clinical care and teaching over the past decade, and who has sought to expand the borders of EBM from a philosophical point of view.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Attitude of Health Personnel
  • Comorbidity
  • Decision Making*
  • Evidence-Based Medicine / standards*
  • Evidence-Based Medicine / trends
  • Humans
  • Philosophy, Medical*
  • Quality Assurance, Health Care / standards