Who's afraid of EBM? Medical professionalism from the perspective of evidence-based medicine.

Evidence-based medicine (EBM) and medical professionalism are two prominent notions in current medical debates. However, proponents of professionalism fear a restriction in doctors' freedom to make their best decisions for individual patients caused by the influence of EBM and highly standardised decision procedures. The challenge which EBM allegedly poses to physicians' discretion forms the starting point for an analysis of the relationship between professionalism, as an inherent value system of medical practice, and EBM, as an approach to optimise the decision-making for individual patients. The analysis starts with a brief conceptual clarification of the ambiguous term "professionalism". It then focuses on three key aspects of medical professionalism which may come into conflict with the basic tenets of EBM. The potential tensions between (a) professional autonomy and clinical practice guidelines, (b) individualised care and standardisation, and (c) esoteric authority and public accountability are analysed and a suggestion for reconcilement regarding each point is made. The article closes with a summary on how a better reflection on medical professionalism may help towards a fuller understanding of EBM and vice versa.