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Evidence or Eminence or Experience

Panchbhavi, Vinod K., MD, FACS, FAOA

Techniques in Foot & Ankle Surgery: September 2018 - Volume 17 - Issue 3 - p 103
doi: 10.1097/BTF.0000000000000213

The author declares no conflict of interest.

After years of training, when we start off on our own, we often strictly stick to what we have learned, and to what was imbibed into us by our mentors, who were constantly hovering and honing our skills. However, over the ensuing years, our practice gets tempered with emerging evidence-based medicine. Further on, as the personal and anecdotal experience grows, our practice becomes laced with what works best in our hands. And where evidence is difficult to establish, what works best in the hands of prominent leaders in the field, becomes propagated as eminence-based medicine. The practice essentially evolves into one that is based on amalgamation of what we were taught: what is currently accepted as evidence or eminence based and what seems to work best in our hands with our own personal experience. If only evidence-based medicine is practiced, and no one pushes the envelope to constantly strive to be the best, then we would see stagnation. That is why, evidence-based medicine of today becomes obsolete in the future, in a constantly tested and advancing field of medicine, with goal posts that move. Eminence-based medicine is similarly challenged.

This current issue of TFAS deals with some of the evolution that is seen in our practice when it comes to managing ankle fractures. For example, the eminence-based practice of considering the size of the posterior malleolus, when fixing ankle fractures, has evolved into current practice where “size doesn’t matter” but “instability” does. We are grateful to Dr Thomas Harris and to the great team of authors. They bring out in this issue the current art and science in the management of ankle fractures, some based on experience, some on evidence, and some on emerging experience of leaders we look up to, to guide our practice.

Like Einstein said, “Not everything that counts can be counted and not everything that is counted, truly counts.” This is true when it comes to counting on the outcome scores touted in scientific studies, even those that are most rigorous and performed to promote evidence-based medicine. Einstein’s quote is also true when it comes to the least scientific ways currently used to obtain patient satisfaction scores to grade physicians and affect reimbursements.

All studies, even those considered robust, end with a sentence or comment that suggests more studies are needed, or concede that there are limitations. Thus, the practice continues to be evidence, eminence, or experience based.

Vinod K. Panchbhavi, MD, FACS, FAOA

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