Médecine fondée sur les preuves (EBM) et recommandations pour la pratique clinique (RPC) : à propos de trois idées fausses

Summary The proliferation and the success of Clinical practice guidelines (CPG) are accompanied by misconceptions about them. In this letter, the three ideas below are discussed with the help of examples. Many of the CPG available are formulated in a way that may lead the reader to believe that: 1) Opinions (including those of expert) have a lower value than the evidence; 2) Situations where we do not have any evidence are quite frequent in medicine; 3) It is acceptable that CPG do not apply to questions that are framed according to Patient, Intervention, Comparator, Outcome (PICOs), and without any indication about the medico-socio-economical setting where the recommendations are supposed to be implemented. These three ideas are mistaken and can lead to recommendations which can annihilate the very principles of CPG.