One of the most difficult aspects of providing health care is the tension that exists between objective evidence, collectively accumulated over generations, and the fact that subjective practitioners deliver care one patient at a time. Although we may strive to understand the continuously developing scientific literature that is the foundation of our understanding of disease, it still remains far from obvious how exactly that literature should be applied to a patient who needs help. In science, the ostensible goal is the generation of data and knowledge that can then be applied as necessary. However, the delivery of health care is not a pure scientific process. There are many cases in which a patient's satisfaction with his or her treatment will take precedence over the provider's view of how well the treatment adhered to the best available evidence. And in the end, all of the evidence in the world may provide little comfort to a patient who has a poor outcome. There is a wide range of variables beyond a provider's control that ultimately may have as huge an impact on a patient's outcome as any randomized controlled trial. Rational decision making is easily disturbed when it comes to factors such as money, time, and emotion. Even when randomized controlled trials exist, it is often unclear how the results should be applied to patients whose profiles do not quite match those of the patients who were enrolled in the trials.
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