As already commented on twitter by four people including me EBM is no cookbook medicine. On the contrary, EBM does take the whole patient into account along with the evidence. EBM tries to find & apply evidence that counts for a specific population. Unfortunately the evidence is often sparser for the young & old.

Isn’t every person unique? Why shouldn’t their treatment be as well. Aren’t patients autonomous person’s free to negotiate their care with physicians? How can all those negotiations turn out the same. Don’t we all have different perceptions and tolerance of risks? and different goals? Why does a committee that doesn’t know me have the right to impose a standardized desirable outcome based on their perception of what the goals of the doctor-patient encounter should be?

I work in UM and have been a medical director in an HMO. I have went to all the meetings and seminars and heard all the “reduce variation” crap and still don’t understand the implied logic whereby it substitutes for the concept of “quality”. It is like using body counts as a measure of military success–it just doesn’t compute and leads to a loss of perception of the real goal.

The ultimate reduction in variation: all the patients die.