Jared Powell:
Today's guest is Professor Gordon Guyatt. Professor Guyatt really needs no introduction because if you are listening to this episode and you're a clinician, you will have been exposed to and are hopefully accurately utilizing his and others creation that is evidence-based medicine or evidence-based practice. Professor Guyatt is a Canadian physician and distinguished professor in the Departments of Health Research Methods, evidence and Impact and Medicine at McMaster University in Canada.
Jared Powell:
In the modern medical landscape, physiotherapy included, it is almost inconceivable to imagine a world without evidence-based medicine. It is ubiquitous. However, this wasn't always the case as recently as 30 years ago. It was commonplace for expert opinion, personal experience, and physiological reasoning to guide clinical decision making. There wasn't an organized library of high quality clinical trials to refer to, which is something we take for granted today. So what is evidence-based medicine? Is it an emotionless data led pursuit that removes the humanity and art out of medicine? Or is this a misconception? Who better than the literal founder of evidence-based medicine to come on and clear up some common myths and misconceptions? Without any further delay, I bring to you my conversation with Professor Gordon Guyatt, professor Gordon Guyatt. Welcome to the show.
Gordon Guyatt:
Thank you very much. Pleasure to be here.
Jared Powell:
Gordon, you are pretty famous in when it comes to your really central role in, as one of the founding fathers of evidence-based medicine, which we were all taught in physiotherapy school. So we can either thank you or hate you for all the late nights that you gave. A lot of us are reading all of your work. Nonetheless, it's a real treat to have you on the show. So, for the physios who maybe don't know you, can you please introduce yourself, maybe a bit of your background and what you're currently doing at the moment?
Gordon Guyatt:
Sure. So I trained as a physician with a specialty in internal medicine. I've been practicing general hospital based, general internal medicine for the last 45 years or so, and have been devoting much of my time to clinical research and to education. And the education focus has been particularly in evidence-based medicine, which is a concept that I helped get going around 1990 as key principles that we need to identify the most trustworthy evidence, summarize it and apply it in our patient care in the context of patient values and preferences. And so I spent the last 35 years or so promulgating and advocating for evidence-based practices in we, in our management of our clinical patients.
Jared Powell:
Lovely. That's your academic career. What about you as a, as a person, Gordon, what do you, what do you enjoy in your time when you're not working?
Gordon Guyatt:
Well, I have a number of close friends who I like to spend time with. I'm married with three kids, which has taken up a lot of my time over the years. And I am an avid mountain biker.
Jared Powell:
Lovely. Plenty of mountains over there in Canada, I assume?
Gordon Guyatt:
Yes. Well, locally we have an escarpment that we call the Hamilton Mountain, although when people come and visit, they say, where's the mountain ? It's a escarpment, actually. .
Jared Powell:
Yeah, I'm from a pretty flat part of Australia, so yeah, any, any slight hill is a mountain for me, so that's fine. I wanna go back into your journey. So qualified as a doctor, what led you into a path of pursuing education and getting into this sort of evidence-based medicine thing?
Gordon Guyatt:
I was a natural educator. Even as a resident, I knew I wanted to be in an academic environment. Initially, though the academic environment was attractive to me, not for research, although it ultimately I spent my life in research. But initially just a, the, the fact that it was an educational environment where initially I was being educated and then as a resident, you're being educated, but as you get to senior residency, you become an educator more and more. And that whole process of education at both ends appealed to me a lot. But then I was introduced, I came along at a crucial time in a crucial place in a histor. The historical phenomenon that became evidence-based medicine was found myself by happenstance in an environment where we had a department led by a visionary by the name of Dave Sackett, who laid the groundwork for what became evidence-based medicine. I was exposed to this, it became, it was enormously attractive to me and determined my subsequent path.
Jared Powell:
Yeah, you were the right man for the right time, which many of these things tend to be, and that's right. Were you were quite a science oriented young man through med school. Were you sort of interested in, in the literature and randomized controlled trials, et cetera, et cetera? Or did that passion come?
Gordon Guyatt:
My first years of training were pre the, even the foundations where we were making our clinical decisions on the basis of physiologic reasoning, our own personal experience, the experience of those immediately around us who are more senior and their perspectives, and what experts in the field, very few, if any of whom understood what became the principles of evidence-based medicine. Those were the ways that clinical decisions happened. It really, it really was people nowadays, it's only people getting around my age who still remember what it was like before EBM. It's actually a lot of people find it inconceivable to think of a world where you didn't look to evidence in the ways that we look to it
Jared Powell:
Sounds like the wild West. I mean, to be fair, in our industry, in physical therapy, allied health, musculoskeletal medicine, to a point, a lot of our theories these days in, in how we judge the effectiveness of our treatments, a lot of it is still rooted in this physiological or mechanistic reasoning, unfortunately, especially on the front line in clinical practice where everybody's got a different theory about how something works and they believe it to work because of this theory. 'cause It's plausible sounds right? Sounds logical, yes. But when you sort of, when you subject these theories to rigorous testing in experiments, a lot of the time these theories don't hold up. There's a famous quote, and I'm, I'm, I'm gonna swear here, Gordon apologies, where science doesn't give a about your feelings or about your belief or about, you know, how you think things work. You it, it either works or it doesn't, you know. So I want to go back to the creation of EBM and we'll talk more about the, the issues in the physiotherapy field later on
Gordon Guyatt:
In terms of your slightly more graphic language, , another one that's relevant is a beautiful theory destroyed by ugly evidence.
Jared Powell:
Is that, is that one of yours or is that a
Gordon Guyatt:
Oh, no, no, no. I don't. The worst.
Jared Powell:
I love it. Yep. I, I totally agree with that. That's more poetic and much more refined than mine. So thank you for that. Gordon. Going back to the start of EBM, so Wild West, it was based on physiological reasoning. It was based on expert opinion,
Gordon Guyatt:
Personal experience.
Jared Powell:
Personal experience,
Gordon Guyatt:
Own personal experience, and the personal experience of senior people around us,
Jared Powell:
Which is still, you know, important forms of knowledge, I imagine. So, and then what did EBM do? What was sa Dave Sacketts role? What was your role? How did it all get going and what was the vision? What was the aim for it?
Gordon Guyatt:
Well, it started, it, it first starts with the principles of clinical epidemiology. We had traditional epidemiology, which was baby C population epidemiology. Does people with hypertension or high lipids get more cardiovascular disease? Do people who smoke get more cancer? Those sort of population based questions. And there were principles that emerged from that were ways of deciding how to decide what's true, because that's the fundamental thing. How do we decide what is true and what is not true? The so there were these principles, and then the notion got the, the notion came around, let's apply these principles instead of two population questions. Let's apply them to what treatments are effective and how harmful are they? What is patient's individual prognosis? How do diagnostic tests work? So these clip, we, we now we're taking the, some of the principles that started as population-based epidemiologic principles and now became what we called clinical epidemiology.
Gordon Guyatt:
And very quickly one of the key principles of clinical epidemiology was, if you want to find out about the effectiveness of treatments, you have to do randomized trials. And that was one that stood the test of time and was a key central principle. You know, then we started saying, oh, okay, well there are randomized trials that are more, that protect better against bias than others. We need to conceal randomization. We need to blind as many of the players in the randomized trial as possible. We need to make sure that we follow everybody up. We need to avoid stopping early when with the apparent early, when we see apparent early benefits, and so on. So we went ahead, yes, randomized trials now to now we define the higher quality of randomized trials. We say, well, there's certain instances in which we need non-randomized or observational studies.
Gordon Guyatt:
How do we do those better? Anyway, there's this body of knowledge and principles that get established for how to do high quality research that will allow strong inferences about treatments or about diagnostic tests or about prognosis. So that body of scientific knowledge, clinical epidemiology, is now building. And as it builds, the obvious thing is sometimes we know, and sometimes we don't know, and we know sometimes we know something clearly works and the benefits and harms, sometimes we know it doesn't. Sometimes we know that it's a close call and the benefits and harms are closely bounds. This is because starting to become clear. And then the next thing that follows is this is should guide our clinical practice, except it's not guiding our clinical practices as we, as we said before, these other things that guide clinical practice and clinicians aren't taught any of this.
Gordon Guyatt:
Anything as you go, nothing. Okay. So the first vision was we've got to start teaching clinicians to be able to look at the medical literature. That was, and it was Dave Sacker called it critical appraisal. And then critical critical appraisal started as a classroom activity. And then he started bringing it into the wards and outpatient clinics where instead of in a classroom, you say, here's how you read a paper. Here's how you distinguish between what's more and less trustworthy to here's a patient, what's the patient's problem, what's the relevant evidence? And that then was a huge, that was a huge step forward. Okay? So it's now saying, okay, we're gonna apply it to an individual patient. And Dave Sackett called that bringing critical appraisal to the bedside. And as we brought critical appraisal to the bedside in the wards and outpatient clinics and really started to do it, we found we were practicing a different medicine. It was a different practice, it was a different feel. It was really, we looked at things very different. And I took over the residency program with a mandate and a vision to now start teaching people to do this new way of practice. And it needed a name. And the name we came up with was Evidence-based medicine, which proved quite catchy.
Jared Powell:
Yeah, it certainly stood the test of time. It's now sort of instantiated in our vocabulary, isn't it? I don't, I don't imagine a time where those three words didn't exist together. So congratulations on that catchy title. So EBM, you've explained its formulation beautifully. What is it? Okay, so, so how do we bring evidence to the individual clinical encounter? How, how do we marry up all those different pillars that you mentioned a moment ago with clinical experience with the best evidence, patient preferences? Like how do we bring all of that together to a particular clinical encounter? Do you have any, any little neat and tidy explanation? Well,
Gordon Guyatt:
I see EBM is having three principles. Number one, certain evidence is more trustworthy than others. And we have we've established now standards that are widely accepted and widely applied, widely applied for differentiating between more and less trustworthy evidence. Second, we need systematic summaries. If we pick out this study from here and this study from there, we're liable to get unrepresented samples of the evidence. And that's big trouble. So we need systematic summaries, what we call systematic reviews of the best evidence. And the third principle is perhaps a little ironic. One, evidence itself never tells you what to do because in any therapeutic or management decision, we have good things. We have we're we have to decide whether to do A and B or B, we have good things about A and not so good things. We have good things about B and not so good things, and somehow we have to trade them off.
Gordon Guyatt:
And that trade off evidence tells you what the benefits and harms are. It doesn't tell you how to trade off the benefits and harms. For that. We need patient values and preferences. So the third key principle of evidence-based medicine is evidence itself never tells you what to do. It's evidence in the context of values and preferences. And so what the clinician needs to do when faced with the patient deciding, helping the patient decide between A and B, they have to understand, they have to have available systematic summaries of the best evidence. They have to be able to understand systematic summaries of the best evidence, including whether we've ended up with high or low certainty of that evidence. And we then need to be able to interact with our patients so that the patients understands the trade-offs and we can help the patient make the best decision.
Jared Powell:
So many things I want to talk about within that particular, that beautiful quote, evidence doesn't tell you what to do. EBM often gets criticized by its opponents for being formulaic and algorithmic and, you know, taking the, the art out of of medicine or, or anything really. But it's, it really couldn't be further from the truth when you explain it in the context of the clinical encounter like you did. Is that right?
Gordon Guyatt:
Yeah, it, it kind of baffles me. The first paper that introduced EBM to the world in a big way was published in German in 1992. And if you go back and look at that paper, you cannot find anything about values and preferences. It's all about the evidence. And over the next, less than a decade, by 1995, we were actually getting it because what what happened was we started, okay, we're out there with the junior colleagues and we're teaching them how to do this. And we say, okay, here's the benefits here, the harm, oh, what do we do now? And historically, we, we were, it, it really is kind of odd how blind human beings can be. We were in a parental culture where the physician decided it was thought that the physician knew what to do, and you just tell the patient what to do.
Gordon Guyatt:
I know what to do, here's what you should do. And we really were not aware that there were underlying value and preference judgements that were being made when we did that. We were not aware when we started EVN, we didn't get it. But then when we started with this process of saying, here's the benefits and the harms, now what do you do? The light started to go on and to say there's value and preference trade-offs that you need to make in going from the evidence to the decision. And by 1995, we were beginning to get it. And then in 2000 in there was a, the these first users guide to the medical literature that we put out as a curriculum for evidence-based medicine. By 2000, we were ready to announce that there is another principle of evidence-based medicine, which is key, which is evidence never tells you what to do. It's evidence in the context of values and preferences. And all our writing since that time has been pushing that point over and over and over again. And there are some people who seem to have missed the last 25 years and are going back to almost 35 years, going back to 1992, where it's true the first paper did not have, we did not get it at that time, but by eight years later, we were announcing it. And that's 25 years ago now. Like, man, get with the last 25 years,
Jared Powell:
How dare you change your mind and try and get better, Gordon, that's it's not allowed. Yeah. It's funny when you do think about it because I've read a lot of your papers and even sackets papers from the nineties, and I think there is a recollection of there being a conversation about evidence must be considered in the context of, of values and preferences.
Gordon Guyatt:
By 1995, we 95 5, yeah, by 1995 we were getting it, but it took till 2000 for us to say this is a core principle of EBM.
Jared Powell:
Yeah. And been a tremendous improvement. So c can I ask, you mentioned a moment ago, and this is a little bit of a tangent, I apologize. You said in systematic reviews you mentioned the certainty of evidence, and I think that's a really important thing that we should touch on. Unfortunately, in our field of physiotherapy, pretty much every meta-analysis that comes out based on low or very low certainty evidence, what does this mean, Gordon? I, I know the answer, but I'd like you to explain it if you can to, to the audience.
Gordon Guyatt:
It means we're not sure simple as that a treatment may work, unfortunately it may not work. And that's what and that's what you're left with. And all of medicine has areas where that is true. The one example that you still have to act, right? So I had a basic bike accident, I guess it's getting onto a couple of years ago, and I hurt my neck fairly badly. And over the next few months I went to a physiotherapist and I went to a chiropractor and I went to an osteopath, and each of those told me what I should do about my problems. And there was quite a bit of overlap in what they told me, not complete, but quite a bit of overlap. But I knew perfectly well that everything they told me had only low quality evidence supporting it. If I did what they told me, maybe it would help. And maybe it wouldn't help, quite possibly it would not, but maybe it would. I did everything, which I thought, okay, maybe, maybe this will help. I did everything and I've gotten better. Whether I getting better, had anything to do with any of those things remains uncertain.
Jared Powell:
Yeah, we don't know the counterfactual
Gordon Guyatt:
Or whether it was just a matter of time, but that's just an example. We are left with uncertainty. And then what do you do in the, and then there's the issue of what you do in the face of certainty. Well, it was a hassle to do all these exercises and things that the person pain, but it wasn't gonna hurt me. So I thought, okay, might as well do it. On the other hand, we have historical phenomena where there were major harms associated with things. And under those circumstances, when you say we're not sure, we're not sure of the benefits, but man there are harms, then maybe that's something to stay away from.
Jared Powell:
Absolutely. There's a professor here in Australia, Tammy Hoffman, she's out of my university, and she, she wrote a great paper about 10 years ago or more now in jama. And she has this beautiful quote in there that, that says, without shared decision making, EBM can turn into evidence, tyranny. What do you make of that quote, Gordon?
Gordon Guyatt:
Well, it's slightly silly to me because without shared decision making, EBM turns into whatever, except that shared decision making and value preferences are at the heart of EBM. So it's like, it's just saying without evidence EBM has a problem. Like, okay, come on. But it's at the core of it, without values and preferences, EBM has a problem, but as the preferences are at the core of EBM,
Jared Powell:
So, so it's, it's sort of, it's included within EBM in its current,
Gordon Guyatt:
As I said, we had. Got it. And we're starting to writing along those lines. In 1995, in 2000, we, we announced it as a central principle of EBM.
Jared Powell:
Yep. So shared just decision making is now incorporated or integrated within the EBM framework.
Gordon Guyatt:
Yeah, the principle is that values and preference, you cannot make a decision without considering values and preferences. That the values and pre, that's the principle. It then follows whose values and preferences. We think it's pretty obvious it should be the patient's values and preferences. How do we ensure that the patient's and preferences are represented in the decision? We do that through shared decision make.
Jared Powell:
Yeah, I agree. It's sort of a bit of an in vogue thing to do at the moment. I find to call yourself an evidence-based practitioner. Everybody seems to be an evidence-based something no matter, no matter what sort of medical field they're in. I feel like it's almost a pejorative to throw around sometimes. Now when you look at people who have, are invoking weird forms of evidence to support their weird and wonderful clinical practice, do you see EBM or being evidence-based as sort of being misused or abused in any way? Oh
Gordon Guyatt:
Yeah, the for sure you have, you've identified that it's now something you have to say, if you are doing a guideline, it better be an evidence-based guideline. And that is sort of a stamp of credibility. However, sometimes when you look at what people are doing, it don't, doesn't actually follow EBM principles. I suppose anti-vaxxers might even say that they are evidence-based, but the evidence that their standards of looking at evidence are not the standards of looking at evidence that EBM would advocate.
Jared Powell:
Yep. I agree. It's a funny old world where you can find evidence to support any position really, but it's the type of evidence that often that people are invoking. You know, it might be a case study, it might be some sort of retrospective study from the 90 that's nineties that supports the, whatever it might be, some mechanistic study that they've found that supports and then they don't look at the more rigorous types of research.
Gordon Guyatt:
Yeah, that's exactly right. So the first principle of EBM is that some evidence is more trustworthy than others, and we have standards to differentiate what is more or less trustworthy. And without those standards, you can say anything.
Jared Powell:
Yep. Many interventions in musculoskeletal healthcare Gordon have what we call a modest treatment effect. It might be statistically significant, but we're not sure if it's a clinically meaningful effect sometimes. And it's sort of, they tend to fall in this gray area of, it may help, it may not help, but it probably won't harm. What should clinicians do in this situation when trying to make clinical decisions and act, as you mentioned a moment ago, in the face of an evidence base that's equivocal in terms of it's not really telling us what to do.
Gordon Guyatt:
You, in what you just said, you harked back to the world prior to 1990 in the language you used there, you said in making clinical decision, that seems to imply that the clinician is deciding what to do, but we have just said it should not be the clinician deciding what to do. It should be a conversation with the patient. So my physiotherapist and osteopath and chiropractor did not say to me, Gordon, I'm giving you this advice, but really Gordon, I don't know if this is gonna help or not. I have my physio, I have my theory about why it should help and my, I sort of have talked to patients and my impression is, should help. But really, Gordon, I don't know the so if you wanna do this, you know, go ahead. I don't think it's gonna hurt you, but it might help if you wanna try it out.
Gordon Guyatt:
That's what they ideally would've said to me. Of course they didn't. They said, here's what I think you should do, but I knew how to interpret what was going on, which is in the way that I just told you. So what I just told you is what you do with that. Right. That's what you do with it. Or even, well, we've got a little more evidence, I'm sorry, Gordon, we've got moderate certainty evidence here now, but unfortunately the moderate certainty evidence suggested benefits are marginal, but it's probably different between, that's on average. That's all we gonna know on average. But maybe there's some, there's probably some people who get more out of it and some people who get nothing out of it. And I can't tell you whether you're gonna be the one who gets more or the one who gets nothing out of it. It's kind of a hassle. You'll find it a pain to do, but, you know, so what do you think?
Jared Powell:
Yeah, no, I totally agree. So what, why do you think that there's so much angst and almost like it's a discomfort when the, and I know this is the case in the medical literature as well as the sort of physiotherapy and allied health literature as well, where it's uncomfortable when the evidence doesn't tell us what to do. And I know we've been talking about that's not the role of the evidence. You've gotta incorporate it with these other things. But still, the day-to-day kind of lay interpretation of evidence-based medicine is that the evidence should tell us what to do. Why do you think this message isn't coming through? What more needs to be done?
Gordon Guyatt:
Well, first of all, human beings do not like to live with uncertainty. Uncertainty is not a comfortable state. We'd prefer to know pretty natural thing. So one of the things that, one of the pushbacks initially to EVM is we were really letting people know how uncertain we are. And that made people uncomfortable. It's just the most natural thing in the world. And unfortunately, the, the public face of medicine, and this was a cata part of the catastrophe in my view, of how the Covid academic was managed. We do not make, we do not highlight the fact that we don't know you should. We're telling you to wear a mask. We're not sure whether it actually helps, but it might stand six feet away from people and they're not sure if it would help, but it might stay out of keep your kids outta school. We're not sure if it helps, but it might, and this time there's a major harm associated with it. The upfront vivid presentation, recognizing uncertainty is something that we do not do across the system in public health and in medical care. We're still way behind where we should be in terms of upfront acknowledgement of uncertainty.
Jared Powell:
Totally agree. It's a, and it's a really noble thing to do as well. You know, when you are really not sure, then we should express that as well. We know that clinicians want certainty, but we also, we know that patients want certainty as well when they're coming to see their doctor or their physio. How do we reconcile the uncertainty that we might get from the literature with perhaps a patient's want for certainty?
Gordon Guyatt:
Sorry, patient. We aren't sure. I know it's uncomfortable. I know we would prefer to be sure, but we aren't. Yeah. Sorry. This is what we have to live with. Yeah. And so then you might help them in a trade off, okay, we're not sure maybe it's gonna help, here's the downsides. And then you try it under those circumstances. You do not pretend,
Jared Powell:
You can't really argue with a patient, though. I don't think if they hear that from a certain practitioner, don't find that compelling and then go to a different practitioner who's providing false certainty. Yeah.
Gordon Guyatt:
Human beings are human beings.
Jared Powell:
Yeah. It's, I guess what I'm trying to get at there. It's a, it's a bit of a tension when you wanna be an ethical practitioner that acts with integrity, but then the patients don't believe you and they go somewhere else to this quite, I mean, that's why every snake oil salesman exists, right? The promise of a better, quite
Gordon Guyatt:
Right. Yeah. Okay. You know, let's live with the world pays your money and it takes your choice. Yeah. And you either, it's an issue of do you, are we going to operate with integrity or are we not? And maybe someday, one of my colleagues, a guy by the name of Vandy Oxman, rightly in my way, in my point of view, thinks this is not gonna really change unless we start introducing it early on in general education. So he has a movement called Informed Health Choices. He is done randomized trials in school-aged children about teaching them the principles, effectively the principles of evidence-based decision making. Wow. And you can teach it in, you can teach it to school kids. And in the day, it's the day ever come where we introduce the notion of uncertainty and trustworthy versus not trustworthy inferences. Andy has shown you can teach it to school kids and the world will change when we start teaching it to school kids.
Jared Powell:
That's amazing. That fill me with absolute joy. I was gonna ask you to finish off, what does the future hold for EBM? And it sounds like that's the future.
Gordon Guyatt:
Poor Andy now has his randomized trials. He goes to school boards and they tell him, sorry, we don't have room in the curriculum. It would be nice if this were the future, but it's a long way off.
Jared Powell:
Gordon, you had to bring me down. I thought that was gonna be a really high note to finish on, but I'm sure, I'm sure Andy's a he's a patient and persistent man and he'll get it done.
Gordon Guyatt:
Yeah. Unfortunately, he's as old as I am, , so it's gonna have to be, it's gonna have to be the next generation who keeps pushing it. But of course he has acolytes around the globe who are trying.
Jared Powell:
That is really fascinating though. I mean, because it's not, it's not really that difficult a concept to understand in its sort of basic formulation, is it?
Gordon Guyatt:
No, no, it's not.
Jared Powell:
Yeah, I, I'm with you. I don't, I don't really understand why people get so confused by it. Like in terms of a randomized control trial, it's good because it minimizes bias, right? And there's good RCTs and bad RCTs, and you had that conversation before. Then you put them together into some sort of systematic review of the literature. And that gives us maybe a, a tighter understanding of this phenomena under investigation. Like it's pretty simple. And then with the patient preferences and the experience and the values and all of this stuff that comes into as well, that's a simple thing to understand. I'm not really asking a question here. I'm just sort of stating, it's kind of bewildering to think about some people's distaste for EBMI really can't understand it.
Gordon Guyatt:
Oh, really? Mm-Hmm . I'm actually somewhat sympathetic. If you are dealing with a rare disease and you know, and you want to advocate for, we, we all want to advocate for our treatments, then you have an expensive treatment and you want to advocate for it. And you go to the people, the policymakers, and they say, well, what's the quality of your evidence? And you're kind of embarrassed or slightly ashed and say, well, it's only low certainty evidence, but, but I still think we should do it much nicer. If you could say it's high certainty evidence. Similarly in the public health field, we should make this public health intervention to improve the health of the community, gonna cost money and maybe have feasibility issues. And then the policymaker says, well, what's your evidence? What's the quality of your evidence? Well, it's only low quality evidence, but I, I still think we should do it. It's not a it's not a comfortable situation. Better to say, oh, okay, we have in public health or rare diseases, we have a different standard. We have a different way of deciding what certainty. And actually this is an eye certainty evidence. I can understand, I can understand the temptation of that.
Jared Powell:
Yeah. Good of you To see, to see the other side. Gordon, you're a better man than I am in closing this conversation. Is there anything else you want to add?
Gordon Guyatt:
No. It's been very pleasant conversation. Thank you very much. I, I think you've done very well in hitting on the key elements of what EBM is.
Jared Powell:
Thank you. I think you've done very well. Funny that as one of the founding fathers of EBM, you've handled yourself very well, Gordon, and I just wanna give a shout out to you from all the physios around the world who have been influenced by all of your work, and not just physios all Allied health. I'm, I'm sorry that the people that you saw over there didn't map out or didn't incorporate your values and preferences and communicate uncertainty. But there are some out there doing a good job, Gordon. So we all wanna say thank you. Thank
Gordon Guyatt:
You. That's very encouraging. A pleasure to hear.
Jared Powell:
Thank you for listening to this episode of the Shoulder Physio podcast with Professor Gordon Guyatt. If you want more information about today's episode, check out our show [email protected]. If you liked what you heard today, don't forget to follow and subscribe on your podcast player of choice and leave a rating or review. It really helps the show reach more people. Thanks for listening, and I'll chat to you soon. The Shoulder Physio Podcast would like to acknowledge that this episode was recorded from the lands of the Ang people. I also acknowledge the traditional custodians of the lands on which each of you are living, learning, and working from every day. I pay my respects to elders past, present, and emerging, and celebrate the diversity of Aboriginal and Torres Strait Islander peoples and their ongoing cultures and connections to the lands and waters of Australia.
