title: Injudicious use of EBM: one step forward, two steps back.
abstract: OBJECTIVE
  The authors are concerned that an overrestrictive approach to evidence-based medicine could lead to the neglect of valuable treatment options.
  
  
  METHODS
  We describe the need for a personalised approach to evidence-based medicine, and support this with examples from ENT practice.
  
  
  RESULTS
  We concur with the point of view that evidence at all levels should be used in clinical decision-making and we suggest that fitness for purpose is more important than hierarchy of evidence.
  
  
  CONCLUSIONS
  We conclude that the application of evidence-based medicine should involve trying to select the best therapy for individuals on the basis of the total spectrum of treatment options. Evidence and expertise should work synergistically.
authors: J A
authors: JA
authors: de Ru
authors: P P G
authors: PP
authors: Van Benthem
authors: G K A
authors: GK
authors: van Wermneskerken
mesh_terms: D003657:Decision Making; D019317:Evidence-Based Medicine / Q000379:methods*; D006801:Humans