Abstract

Clinically relevant attitudes and guidelines issued by a rational evidence based medicine (EBM) approach, integrate individual clinical expertise with the best available external clinical evidence from systematic research. Many surgeons, however, while considering the ultraliberal world they are practising in, and fearing that the primary goal of managed care in a market environment is reducing cost in order to make profit or decrease spending, remain suspicious of this kind of tentative protocol driven medicine when applied to surgical practice. If surgeons want to develop a health policy agenda that emphasises patient care issues above providers’ or payers’ interests, they should also enhance education programmes, improve continuing objective assessment of the way surgery is performed, face moral issues raised by innovation, and assume an increased leadership role in sound critical evaluation of non-validated new techniques. They should no longer consider EBM as a weapon turned against the surgical profession, but rather see it as a tool that may provide some answers to chronically unresolved questions in the evolving art of surgery.