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Clinical decisions should, as far as possible, be evidence based. So runs the current clinical dogma. 1 2 We are urged to lump all the relevant randomised controlled trials into one giant meta-analysis and come out with a combined odds ratio for all decisions. Physicians, surgeons, nurses are doing it 3 â[euro]" 5 ; soon even the lawyers will be using evidence based practice. 6 But what if there is no evidence on which to base a clinical decision?
Participants, methods, and results
We, two humble clinicians ever ready for advice and guidance, asked our colleagues what they would do if faced with a clinical problem for which there are no randomised controlled trials and no good evidence We found ourselves faced with several personality based opinions, as would be expected in a teaching hospital. The personalities transcend the disciplines, with the exception of surgery, in which discipline transcends personality. We categorised their replies, on the basis of no evidence...