Evidence-based psychiatric practice: doctrine or trap?

Medical practice has rapidly shifted towards an 'evidence-based' approach. While there are acknowledged clear benefits to this, a number of pitfalls a re frequently not appreciated. Perhaps the most important limitation is the extent to which the current body of data is inadequate for many common cli nical decisions. Algorithms risk being developed, frequently by third parti es, without acknowledgement of these limitations and with substantial impli cations for clinical independence and the quality of patient care. This pap er discusses potential problems of the evidence-based approach and suggests possible guidelines for the management of clinical decisions given the lim itations of data-based guidelines.