We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Viewpoint |

Evidence-Based Practice Is Not Synonymous With Delivery of Uniform Health Care

Benjamin Djulbegovic, MD, PhD1,2; Gordon H. Guyatt, MD, MSc3
[+] Author Affiliations
1Division of Evidence-Based Medicine, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa
2H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
3Department of Clinical Epidemiology, McMaster University, Hamilton, Ontario, Canada
JAMA. 2014;312(13):1293-1294. doi:10.1001/jama.2014.10713.
Text Size: A A A
Published online


Current clinical practice is characterized by substantial variation in delivery of health care for the same conditions.1 In turn, clinical variation is considered one of the major drivers of ever-increasing health care costs1 contributing to the estimated 30% of inappropriate or wasteful health care.2 Perhaps as a natural response to this unsatisfactory situation, a widespread and influential school of thought has emerged contending that greater uniformity of clinical practice is desirable.1,3 Advocates maintain that by achieving uniformity in care, practice variation can be decreased, in turn leading to large cost reductions. The suggested mechanism to achieve uniformity in part involves clinician adherence to practice guidelines, which is seen as synonymous with evidence-based practice.3 In this Viewpoint, we explain that this position is based on a misunderstanding of trustworthy guidelines4 and that striving for uniformity of practice as an end is misguided.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

10 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles

Care at the Close of Life: Evidence and Experience
What Should the Physician Expect of the Hospital-Based Palliative Care Service?