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Three Part Question

In [medicine] is [evidence better than expert opinion] for [choosing the most effective therapy]?

Clinical Scenario

During a lull in the action over the Festive Season, an Academic ST trainee and a Specialist Registrar are discussing a case. The ST trainee cites a paper to back up his arguments. The Specialist Registrar ignores the ST trainee, claiming that his experience and "old school expertise" are obviously superior.

You wonder whether evidence-based medicine is truly superior to expert opinion. Expert opinion holds that evidence-based medicine is superior. But what does the evidence say?

Search Strategy

Ovid Medline 1950 - August Week 4 2008
[exp Evidence-Based Medicine/ OR evidence.mp.] AND [(expert OR faith OR authority).mp.] limit to humans and English language and Ovid [Comparative Studies] filter.

Search Outcome

238 papers were identified. None addressed this perplexing question.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses

Comment(s)

The authors did find an interesting a case study which suggested that “experts” were less successful than a more “naïve” junior colleague in identifying relevant papers from a literature search (Dornan et al 2007). Maybe “experts”, with their accumulated wisdom, find it harder to be objective than the junior colleague. In any event consensus between reviewers seems an important element in quality assurance of any evidence found.

Clinical Bottom Line

In the authors’ humble opinion there is no evidence, using this method, that there is any evidence that evidence-based medicine is superior to expert opinion. Local advice, including common sense and good-will to all men, should be followed.

References

1. Dornan T, Littlewood S, Margolis SA, Ypinazar V, Scherpbier A, Spencer J. Identification of best evidence in medical education. Case study. Medical Teacher 2007; 29(4):e72-75.