So is it all just another fashion that will come and go

For some, the whole concept of EBD might seem like just another new management-driven fad that will come and go like others.14 Perhaps it is the shame in admitting that some of our previous treatments might be wrong that prevents progress -the "elephant in the front room" that doctors keep bumping into without seeing.23 Yet what is the alternative to EBD? Is it anecdote-based medicine ("I once treated a patient with such and such with remarkable effect..."), entropy-based medicine, or propaganda-based dermatology driven by powerful cartels with vested interests? I cannot believe that any caring dermatologist would not wish to base his or her treatments on the best external evidence. Two studies have already shown that dermatologists use as much high-quality external evidence to inform their treatment decisions as other specialists.24,25

It is reasonable at this point to ask "What is the evidence for EBD?". This is a tautological question as it implies that there is a group of doctors who are evidence based and another group who are not, whereas the reality is that we conform to a dynamic and complex continuum. Some are more EBM-orientated than others, but we all practise EBM to some degree, this rendering traditional comparisons through designs such as RCTs difficult to interpret, quite apart from ethical issues.15

Perhaps it is the name "evidence-based medicine" that is at fault here since it implies that anyone who does not call himself or herself an EBM physician is not one. This binary thought disorder is clearly an inaccurate reflection of real life. Like Moliare's bourgeois gentilhomme, who, after 40 years, discovered that he had been speaking prose without realising it, many dermatologists have been practising, and will continue to practice, high-quality EBD. Yet we all need to learn new skills in searching, appraising and translating the evidence. Now it's up to you.

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