ABSTRACT
By the turn of the century, the evidence was being incorporated into clinical guidelines, directing decisions regarding diagnosis and management in specific areas of health-care. Guidelines usually include consensus statements of what is considered to be best practice and often algorithms to aid decision-making. As the stack of guidelines accumulated on the consultation room floor, increased effort went into the implementation of guidelines, now a research topic in its own right. There is no doubt that understanding and applying robust scientific evidence from well-conducted trials can improve patient care and health outcomes. For example, achieving quality targets may result in significant health gains among patients with cardiovascular disease. Best practice requires the synthesis of scientific knowledge, the context in which it is applied and 'phronesis' – the accumulated wisdom of the practitioner. Empirical evidence contributes to management decisions made by doctors and their patients but cannot supplant the contextual knowledge that both contribute.
