It's not the evidence, it's the way you use it: is clinical practice being tyrannised by evidence?

Abstract

?Good doctors use both individual clinical expertise and the best available external evidence, and neither alone is enough. Without clinical expertise, practice risks becoming tyrannised by evidence, for even excellent external evidence may be inapplicable to or inappropriate for an individual patient.?1 (p. 72) I am a senior physiotherapist and clinical researcher and in the comparatively early stages of a sero-negative spondyloarthropathy that may well develop into full blown ankylosing spondylitis (AS). The severity of my symptoms was such that in 2005 I had to relinquish the full-time position I had held for 21 years and reduce my working hours to 12 hours per week in a nonclinical role. To set the picture of my symptoms at their worst, I was unable to sit for more than a few minutes a day because of severe axial pain, forced to do all work in kneeling, standing or lying positions, with social activities likewise restricted. In order to sleep I often needed strong analgesia and icepacks, only to wake 2?3 hours later. Life was pretty tough. After little response to conventional medications, I started a tumour necrosis factor a (TNF-a) blocker (Infliximab) in March 2007 with a significant and dramatic response. As well as markedly decreasing my pain and fatigue, and improving range of movement, function and quality of life, Infliximab has enabled me to commence some additional part-time work as a medical writer.