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EBM cannot be just what has always been done - there is too much variation and even inhumanity in doctor behaviour for that to be the case. EBM is also not ivory tower or armchair medicine but a way of staying on top of a busy professional life. It is not an alternative to experience.
EBM is also not cook-book medicine imposed from above and slavishly followed but an active process which integrates the doctor's own expertise, the external evidence and the patients' preferences. Clinical guidelines are similarly subject to this flexible approach.
External clinical evidence can inform but never replace individual clinical expertise and it is this expertise that decides even whether the external evidence is relevant to the patient at all.
EBM is not a cost-cutting exercise but a method of looking for the most effective ways to improve the quality and quantity of patients' lives. This may in fact raise, not lower, the cost of care.