Pragmatic Versus Evidence Based Medicine-it's not either-or.

Abstract

Pragmatism in medicine remains largely unacknowledged, undefined and un-described. We argue that it should not be viewed as an antithesis to evidence based approach, but rather as a way of solving a clinical problem whilst acknowledging limitations arising from the context in which the care is provided. The imperfection of the approach may be its strength, as uncertainty demands continuous re-appraisal of the situation. Existence of readily available evidence, compiled in a guideline may be an advantage, but is not a prerequisite for success. Indeed, the evidence based approach is not perfect and its application meets a number of limitations. We would like to assert that pragmatic approach focused on seeking the most available, given therapeutic context, solutions remains the most available and efficient in present day medical practice. It fills many holes between the academic perfection of research and vast heterogeneity of individual patients and clinical contexts.