Clinical uncertainty

In 2003 the ear, nose and throat specialist Richard Rosenthal published a commentary in which he coined the term 'uncertainty based medicine' ('UBM'). With this tongue in cheek reference to the popular term 'evidence based medicine,' Rosenthal called for acknowledgment that clinical uncertainty is an essential component of any model of contemporary health care practice.2 More recently, Jamison has noted that 'As clinical outcomes are increasingly recognized as being unpredictable, uncertainty becomes the norm in clinical care.'3 Such positions are in stark contrast to sentiments expressed in some accounts of the scope of evidence-based practice ('EBP'). For example, the mission of the British Medical Journal Evidence Centre is apparent in its internet mantra: 'Eliminating uncertainty from health care.'4 One might think that if, indeed, this was the potential of EBP, there would assumedly be no argument with the edict of Muney that '... physicians who violate its precepts should ultimately face license suspension.'5 Challenges to the concept of EBP are, however, not uncommon in health care literature, and many attempts to categorise the pitfalls in or objections to practitioners adopting EBP have been advanced. Whilst it is by no means complete, this paper offers a brief compendium of some commonly cited critiques.