The Journal of Bone and Joint Surgery (American). 2009;91:1264-1273.
doi:10.2106/JBJS.H.00036
© 2009 The Journal of Bone and Joint Surgery, Inc.
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Orthopaedic Surgeons: Artists or Scientists?*

Emil H. Schemitsch, MD, FRCS(C)1, Mohit Bhandari, MD, MSc, FRCS(C)2, Michael D. McKee, MD, FRCS(C)1, Rad Zdero, PhD3, Paul Tornetta, III, MD4, J. Bartley McGehee, MD5 and Richard J. Hawkins, MD, FRCS(C)6

1 Division of Orthopaedics, Department of Surgery, University of Toronto, 800-55 Queen Street East, Toronto, ON M5C 1R6, Canada. E-mail address for E.H. Schemitsch: schemitsche@smh.toronto.on.ca
2 Department of Clinical Epidemiology and Biostatistics, McMaster Health Sciences Centre, 1200 Main Street West, Hamilton, ON L8N 3Z5, Canada
3 Martin Orthopaedic Biomechanics Laboratory, Shuter Wing (Room 5-066), St. Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada
4 Department of Orthopaedic Surgery, Boston University Medical Center, 850 Harrison Avenue, Boston, MA 02118
5 Tennessee Orthopedic Alliance, Williamson County Medical Center, 600-4323 Carothers Parkway, Franklin, TN 37067
6 The Steadman-Hawkins Clinic of the Carolinas, 1690 Skylyn Drive, Spartanburg, SC 29307

The first 150 words of the full text of this article appear below.


   Introduction
 
The practice of evidence-based medicine has evolved and entered the rubric of most clinicians during the past several years. Gordon Guyatt, who first coined the term evidence-based medicine in 1990 at McMaster University, conceptualized the practice of evidence-based medicine as the integration of clinical expertise with the best available clinical evidence and patients' values1,2. The term best available evidence implies a hierarchy of evidence with highly valid and believable studies at the top and less valid evidence at the bottom2.

The motivation for this concept has been a desire to minimize the potential harming of patients by basing clinical decisions on the sorts of evidence that are least likely to be wrong. The increasing degree of potential bias in the design of studies has been categorized as follows3: systematic reviews of randomized controlled trials that reveal differences in treatment effect (heterogeneity) and individual high-quality randomized controlled trials . . . [Full Text of this Article]


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