Evidence-based practice: not just a professional choice; an ethical obligation

In a recent, very challenging interaction with a senior physician in a receiving facility, i found myself having to stand very firm against the prescribed advice, for the good of the patient faced by the clinical team. In the aftermath of that interaction, a mentor sent me this quote from Brené Brown :

“When I asked people, where did you muster up the courage? How did you script the courage to do this? The answer was always, I got very clear that being courageous was more important to me as a value than succeeding.”

In the world of emergency medical care, standing up for what’s best for the patient doesn’t always win popularity points—especially when it goes against hierarchy or longstanding traditions. Sometimes, despite mounting evidence, we’re met with resistance when advocating for a patient-centered, evidence-based approach. Yet, the courageous choice often means taking that stand even when the outcome is uncertain, and even when it means standing against the advice of the receiving provider.

It’s not simply about defying convention; it’s about ensuring the right care in that moment, knowing it’s backed by science and experience. This choice can feel isolating—especially in handovers to colleagues who may approach the situation differently or resist new data in favor of entrenched methods. And yet, as highlighted above, courage must sometimes take precedence over comfort or approval.

The Risks of Challenging Dogma in Medicine

Dogma in medicine often masquerades as unyielding truths. While hierarchy and established protocols certainly have their place in maintaining safety and standards, these structures can sometimes become barriers, particularly when newer research or patient-specific evidence challenges the norm. Choosing to speak up for the patient, even when it may not be the popular choice, takes resilience—and allies who understand that courage are sometimes more critical than immediate validation.

Where Evidence Becomes Our Baseline

The commitment to evidence-based practice is not just a professional choice; it’s an ethical obligation. When we base our clinical decisions on current, validated evidence, we align ourselves with a standard that transcends personal opinion. However, it’s not uncommon to face resistance from those who may feel threatened by evolving standards or unwilling to adapt.

To my colleagues in emergency medical care: When have you faced moments where you had to stand alone, advocating for the right course of action despite the discomfort or opposition it brought?

I’d love to hear from you. Share a moment when you needed to hold firm to your values and evidence, even when it wasn’t easy, when the room was filled with resistance, or when the hierarchy pushed back. Your stories of courage remind us that standing up, especially in the face of doubt, often leads us closer to the kind of care we all believe in.