Injudicious use of EBM: one step forward, two steps back

Injudicious use of EBM: one step forward, two steps back. Problem: The authors are concerned that an overrestrictive approach to evidence-based medicine could lead to the neglect of valuable treatment options. Methodology: 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. Conclusion: 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.