Introduction

Abstract

At the center of medical decision-making is always the patient; their story, their feelings, their family support and their unique perception of the problem. At this intersection of medical art and science stands the surgeon who must combine the unique aspects of the ancient art of healing with modern medical science to provide the treatment most likely to create a good outcome. Instinctively we as surgeons tend to rely on impressions from our clinical practice, experiences during surgical training, or maybe what we have just heard at the morbidity and mortality conference this week. This anecdotal decision making, while typically thought of as rudimentary and not “evidence-based”, is in fact one of the most basic forms of evidence based medicine(EBM). This method of medical practice has been known since antiquity where early EBM was based on ancient historical or anecdotal accounts. Teaching during this time was mainly authoritative and passed on with stories. By the seventeenth century, a renaissance era of medical practice had ushered the earliest form of modern EBM. During this period, written journals were kept and textbooks began to become more prominent.

Where is the wisdom we have lost in knowledge? Where is the knowledge we have lost in information?T.S. Eliot 1934