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I know lots of doctors who are sick of the "EBM" constantly shifting and changing - "don't use normal saline in renal failure? But the latest multicentre RCT showed no difference..." The whole point is that we try to keep up to date, remain relevant and try to incorporate what we think is best practice. We don't have to have the perfect answer, or the right answer, but we should be trying to get there all the time.

EBM is still a relatively young trend in my country (20 years?) and we see many young physicians really caught up in “what’s the evidence” — and while that is a great instinct to have, I have sometimes been the voice of dissent pointing out that while statistics and scientific methodology are fantastic tools for deriving and refining general principles of care, every individual case is ultimately a crap shoot. We never know which patient is going to upturn our expectations and convictions.

I don't think this is necessarily true. You've mistaken the patient population and the general population. It'd be like saying sickle cell research doesn't hit the majority of the population because most studies are necessarily done on black people and they make up the overwhelming majority of the SCD-affected. Likewise, you'll often find more men in CAD studies because they suffer from it significantly more often and at a younger age-