The idea that doctors should base their treatment decisions on good evidence seems such an obvious and common sense notion that it might be taken for granted. If the practice of evidence-based medicine (EBM) goes without saying, what is point of discussing and promoting EBM? Medicine is advancing very rapidly, creating major changes in the way we treat our patients. We must keep up with such changes. Although we need to keep up to date with such new external evidence, we frequently fail to do this when we rely on passive sources such as a visit from a pharmaceutical representative or an occasional flick through the main journals. This leads to a deterioration of our knowledge with time. Systematic reviews which have searched for all relevant data are needed nowadays to update dermatologists on current best treatment. Attempts to overcome this deficiency by attending clinical education programmes fail to improve our performance, whereas the practice of EBM has been shown to keep its practitioners up to date.1 This does not mean that information technology skills replace those attributes of being a good doctor, such as history and examination skills. As the original definition in Chapter 2 implies, the practice of EBM is a synthesis of knowledge management skills with clinical skills. The aim is to create an emergent skilful, caring and efficient doctor.
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