Instinct based medicine?
Evidence based medicine is a relatively new approach to medical practice. It uses the findings and recommendations of the best available scientific research. Decision analysis and evidence based medicine began to appear in the medical literature in the early 1980s and have gradually been encouraged and advocated.1 But what defines “evidence?”
During a neurology elective at one of Saudi Arabia’s biggest hospitals, I discussed the case of a patient with severe internal carotid artery stenosis with a consultant neurologist. Trying to impress him, I asked if he preferred to manage such patients using a carotid endarterectomy or a carotid stent. I mentioned that recent studies23 have shown a better long term outcome with carotid endarterectomy. He replied: “I’d still go with the stent.” I sensed that he had a point to make, so I asked: “But evidence based practice . . . ” but before I could complete my sentence,