The individual patient and evidence-based medicine - a conflict?

The doctor-patient relationship is characterised by clinical situations that reflect different degrees of impairment of the patient's quality of life on the one hand and different degrees of threat to the patient's life on the other. Typical patterns of these situations from absent or minimal to severe impairment of well being or threat to life are described. With regard to this, the doctor-patient communication is still suffering from considerable deficits. For the latter, a possible philosophical framework and reason is given. The potential of evidence-based medicine to ease this conflict by bringing into the game the current best-available scientific evidence is discussed, and some inherent serious limitations of evidence-based medicine are shown. Besides these drawbacks, doctors are usually very reluctant and lazy to integrate evidence-based results into their daily practice. In the author's view, evidence-based medicine is a reasonably new tool. However, it should not yet be overestimated in its potential to influence and improve daily clinical practice.