The Professional Practice Committee of the American Diabetes Association would like to thank McCormack et al. (1) for their thoughtful letter regarding the American Diabetes Association’s Standards of Medical Care in Diabetes (2). While the committee agrees that shared decision making is a valuable aspect of diabetes care and that multivariate risk models can be developed using data from clinical trials to estimate each individual’s benefits and risks associated with each intervention, that process would be incredibly labor intensive and would make the Standards long and unwieldy.
A major limitation of evidence-based medicine relates to the limits of the scientific method in clinical practice (3). Clinical decisions involve people, and the application of research into clinical practice must take account of people in their social context. Clinical judgment is central to clinical practice and involves weighing the benefits and risks of any medical choice in consultation with the individual patient.
As stated by Sackett et al. (4), “External clinical evidence can inform, but can never replace, individual clinical expertise, and it is this expertise that decides whether the external evidence applies to the individual patient at all and, if so, how it should be integrated into a clinical decision. Similarly, any external guideline must be integrated with individual clinical expertise in deciding whether and how it matches the patient’s clinical state, predicament, and preferences, and thus whether it should be applied.”
Clinical guidelines are the foundation for evidence-based medicine. A patient-centered approach is critical to their application. No clinical practice guideline can address all of the clinical and behavioral complexities of an individual patient. Doing so invokes the art of medicine, which should be informed by clinical practice guidelines.
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Duality of Interest. No potential conflicts of interest relevant to this article were reported.
