title: Looking for rules in a world of exceptions: reflections on evidence-based practice.
abstract: 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.
authors.affiliation: Sunnybrook and Women's College Health Sciences Centre, Toronto, ON, Canada. ross.upshur@sw.ca
authors.forename: Ross E
authors.initials: RE
authors.lastname: Upshur
mesh_terms: D001291:Attitude of Health Personnel; D015897:Comorbidity; D003657:Decision Making; D019317:Evidence-Based Medicine / Q000592:standards* / Q000639:trends; D006801:Humans; D010686:Philosophy, Medical; D011785:Quality Assurance, Health Care / Q000592:standards