TY - JOUR T1 - EBM, the once and future paradigm JF - British Journal of General Practice JO - Br J Gen Pract SP - 478 LP - 479 VL - 55 IS - 515 AU - Toby Lipman Y1 - 2005/06/01 UR - http://bjgp.org/content/55/515/478.abstract N2 - It's now about 10 years since I was introduced into the world of evidence-based medicine (EBM). It was claimed to be a new paradigm, a marriage of epidemiological analysis with clinical insight and creativity. Perhaps the most radical implication of the new discipline was the idea that experts, whether in the form of senior clinicians or researchers, no longer had the right, or the need, to impose an approved model of clinical practice on ordinary clinicians and their patients. We EBMers, with our critical appraisal checklists and ability to explain Odds Ratios, did not need experts to tell us what to do. We would formulate structured clinical questions in collaboration with our patients and then find and interpret the best evidence to solve each individual patient's problem.It's difficult now to recapture the excitement of that time, the feeling that a whole tradition of authoritarian practice was about to be swept away by a flood of evidence-based rationalism. I remember vividly the way I struggled to understand basic epidemiological concepts, and how they transformed my view of the implications of research evidence for a given clinical situation. Because that was really the point of EBM — not the evidence itself, but its relationship with the complex world of patients' multiple problems and varying, sometimes contradictory, wants and needs. You couldn't really grasp the essence of EBM unless you were a clinician, because it was founded on the idea that it was the ability to identify and define a specific lack of knowledge about how to tackle a problem arising in clinical practice that should set off the whole process of evidence-finding and interpreting. You didn't have to be a card carrying member of the David Sackett fan club to feel at least a little seduced by this re-alignment of the … ER -