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Commentary
Sep 12, 2011

Evidence Under JudgmentCan We Oversee Our Own Decision Making?

Arch Intern Med. 2011;171(16):1496-1497. doi:10.1001/archinternmed.2011.355

You cannot solve a problem from the same consciousness that created it. You must learn to see the world anew.
Albert Einstein

In defining evidence-based medicine, Sackett and colleagues1 stated that practicing it “means integrating individual clinical expertise with the best available external clinical evidence from systematic research.” Fifteen years later, the regulatory pendulum has swung far toward the preference for the latter and away from the former. Most recently, the proposal by the White House to immunize physicians who follow evidence-based practice guidelines from malpractice suits signals a tacit encouragement to continue in the same direction, further limiting individual clinical judgment.2 The accelerated pace of implementation of best evidence into clinical practice was a natural response to the shocking magnitude of harm associated with health care delivery.3 However, the lack of significant gains despite a decade of dogged effort requires reflection on some cognitive and statistical concepts, which in combination may explain this apparent failure and help chart a corrective course.4

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