Medicina interna, paziente complesso, evidence based medicine e le non evidenze

The “evidence-based medicine”, as other models of care, has - in itself - some limitations. “No evidence in medicine” matters that the postulates of the EBM are not always applicable to the real patients of Internal Medicine wards, mostly elderly, frail, complex, with comorbidities and polipharmacy, often with cognitive dysfunction and limitation of autonomy, with psycho-emotional, social and economic problems. The interacting effects of overall involved diseases/factors and their management require more complex and individualised care than simply the sum of separate guideline components. Further innovation is required to resolve the need to enhance integration of evidence with our patients' values at the “bedside and/or clinic” management.