It’s suggested, often by those who are faced with EBM as a rather coarse stick waved to stop them acting in one way, or to force them to act in another, that practicing EBM destroys any ‘art’ in medicine.

I’d argue that it integrates and emphasises the need for art. The three-ringed combination of good quality science, a clear understanding of our expertise in delivery and a requirement to share the information and decision making processes with our patients, their parents (or all of them) makes clear that the ‘arts’ of communication, interpretation, and facilitation are essential. Any anyone who uses a guideline without seeing the GUIDE of the line it describes is failing their patients. (I’ve not found any evidence for this yet — but I do believe that if a guideline achieved >95% compliance then it’s either a technical SOP or someone’s doing it wrong and not spotted the patient that needed to be treated differently.)

There is science in each of our ‘arts’, like diagnosis. And some of these arts are teachable. But the essential part of all these ‘arts’ is that they require mastery by practice. So become EBM masters, and practice away, using arts to be guided by science to deliver excellent care.

– Archi