Why EBM won’t fly in the United States

There is an interesting discussion going on at Blogborygmi. Nick applied the evidence-based Ottawa ankle rules in a situation, only to be overruled by his attending – “in our country, I can’t afford not to get an X-ray.” Discussion ensued in the comments, with arguments discussing whether EBM is merely a cost-containment strategy versus good medicine.

I would agree with the attending in this case. Until physicians are sued for doing too much testing, I will always err on the side of extra testing. Cover-your-ass indeed. The reality is this – they always get you for the zebra you miss. We are in a nation where physicians are practicing two forms of medicine – “correct”, evidence-based medicine and United States-style, defensive medicine.