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On rounds or in clinical conferences, doctors debated the design and results of numerous research studies.

Whereas data per se may be objective, their application to clinical care by the experts who formulate guidelines is not.

This truth, that evidence-based practice codified in clinical guidelines has an inescapable subjective core, is highlighted by the fact that working with the same scientific data, different groups of experts write different guidelines for conditions as common as hypertension and elevated cholesterol levels The specified cutoffs for treatment or no treatment, testing or no testing, the weighing of risk versus benefit — all necessarily reflect the values and preferences of the experts who write the recommendations.

A customer or consumer is guided by “caveat emptor” — “let the buyer beware” — an adversarial injunction and hardly a sentiment that fosters the atmosphere of trust so central to the relationship between doctor or nurse and patient.

Reducing medicine to economics makes a mockery of the bond between the healer and the sick.

In contrast, clinical judgment is cast as subjective, unreliable, and unscientific.

But there is a fundamental fallacy in this conception.

Now some prominent health policy planners and even physicians contend that clinical care should essentially be a matter of following operating manuals containing preset guidelines, like factory blueprints, written by experts.

These guidelines for care are touted as strictly scientific and objective.

Furthermore, the term “provider” is deliberately and strikingly generic, designating no specific role or type or level of expertise.

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