Shared decisions: The art of healthcare

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Care guidelines, quality measures, and evidence-based medicine lead to an appearance that the practice of healthcare is an exact science with one right way to do things. However, the evidence we know is only a sliver of reality, and it is constantly developing and changing. Science is simply a guide to healthcare that, combined with the art of healthcare, leads to the actual practice. Decisions require finesse and dialogue, ascertaining what is appropriate for each individual patient, but taking into account the unique characteristics of each individual.
The science of healthcare is not static. Twenty-five years ago, evidence-based medicine told us that beta-blockers were contraindicated for patients with heart failure (HF). Now, evidence-based medicine recommends beta-blockers as the treatment of choice for patients with HF.1 Science (the evidence) is only what we know at the moment. Our knowledge (the evidence we know) will change over time.
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