It has become axiomatic that high quality health care requires application of the best available evidence in the context of the individual patient’s situation. Medical schools and residency training programmes are required to provide training in critical appraisal of the literature, and no self respecting guideline would claim to be other than “evidence based”. In spite of this wide acceptance of evidence based medicine as the right thing to do, it is clear, from studies such as the one by Riordan et al in this issue, that we are just not quite there yet.¹ These investigators wondered whether “best paediatric evidence” was accessible and used by on-call doctors working at inpatient paediatric and neonatal units. What they found was perhaps predictable: the sources they defined as “best paediatric evidence” were generally accessible, but they were not often used.

Other studies suggest that the problem is widespread: only a minority of Canadian internists reported using evidence based information sources,² and similar results were found on a survey of family practitioners in New Zealand.³ Fewer than 5% of Australian general practitioners had ever used the Cochrane Library in 1999.⁴ Insufficient time, inadequate skills, and limited access to evidence are the most commonly cited reasons that physicians give for not seeking and using evidence more consistently.⁵

The practice of evidence based medicine has been conceptualised as a five step process: recognising information needs and describing them in well formulated clinical questions; efficiently finding information; critically appraising the information; applying the …