I practice evidence based medicine as much as possible. The trouble is that patients have a very hard time understanding it, let alone appreciating it.

I don't give antibiotics for colds, but those patients often go see other doctors to get their antibiotics. When they get their inappropriate prescription, ironically I come across as a bad doctor for not prescribing it in the first place.

When people bring their kids in to get some gravol for their viral gastroenteritis, I tell them that it has been shown to be no better than placebo, so I don't offer it. Parents hate that.

I have a cranky baby at home. My friends asked me why I don't use Oval. I told them that there is evidence that it doesn't work. They stared at me like I had three heads. After all, they tried it and it worked for them!

People come in with back pain. My job is to rule out the dangerous causes, and once that's done give them some analgesia and tell them to weight a few weeks for it to improve. Any serious pathology will reveal itself over time if there are no red flags during the initial history and physical. Patients hate that. They want the xray. So they go to their chiropractor who orders a bunch of xrays (placebo 'tests' are very therapeutic to patients actually). "Well, your xray looks fine!"

EBM is hard on the practitioners. The old school of medicine is to say, "This is what you have and this is what you need to do to fix it."

Now we say, "It's likely that you have this, although I can't say for certain. Here are the pros and cons of the treatments. Now what would you like to do?"
Very dissatisfying to a lot of patients.

Everyone wants all the scans and tests even when it doesn't make sense, because they all know the guy who was told that his problem wasn't serious and it turned out to be cancer etc.

The previous party line was that all diabetics should be on aspirin to decrease their chances of having a heart attack. A recent study came out showing very little evidence for primary prevention of heart attacks with aspirin. What to do now? How to integrate every little bit of often conflicting evidence into clinical practice? It's very hard to stay up to date, let alone sift the wheat from the chaffe.

EBM is the gold standard of how we should practice medicine. Yet it is immensely frustrating to put into actual practice.

Bingo.

I have never used half the crap I took in undergrad. There are two reasons why they include most prereqs.

1)hoops to jump through.
2)most people in 'pre-med' (which doesn't exist in most Canadian universities now) don't get into medicine, so they still need basic science to have some relevant skills in another field.

And as to the article that talks about science leading to research. Many don't like research. To castigate the clinician as mediocre because they don't do research is grotesquely unfair.