SGEM Xtra: Dr. Gordon Guyatt – Legend of Evidence-Based Medicine

Date: September 22, 2026

Dr. Gordon Guyatt

Guest Skeptic: Professor Gordon Guyatt is a physician and Professor of Health Research Methods, Evidence, and Impact at McMaster University, with a joint appointment in Medicine. He coined the term “evidence-based medicine” in 1990, helped introduce the concept more widely through the 1992 JAMA paper, was central to the Users’ Guides to the Medical Literature, and has played a major role in the development of GRADE.

This is another SGEM Xtra in our Legends of EBM series. The idea is to talk with some of the people who helped shape not just what evidence we use, but how we think about evidence.

One thing I enjoy about these interviews is hearing the story behind the CV. The papers tell us what was published, but not always why people became interested in the questions, what the arguments were at the time, or how things might have gone differently.

Five Questions for Dr. Guyatt

Question 1: The Superhero Origin Story

Every superhero needs an origin story. What turned young Dr. Gordon Guyatt into an EBM superhero? You trained at McMaster and found yourself around people like Dr. David Sackett and Dr. Brian Haynes while clinical epidemiology was taking shape as a discipline. What was going on at McMaster at the time that made you start asking, “How do we actually know this is true?”

Question 2: What’s in a Name?

We need to talk about the name itself. When you became residency director, you needed a name for the approach you wanted to teach. Your first attempt was “scientific medicine,” which apparently did not go over very well with some of your colleagues. You went back to the drawing board and came up with “evidence-based medicine.” What happened?

The phrase appeared in your 1991 ACP Journal Club editorial, and then in the 1992 JAMA article from the Evidence-Based Medicine Working Group, which called EBM a “new paradigm” for medical practice and teaching. Did you really see it as a new paradigm, or were you being deliberately provocative?

Question 3: From a Philosophy to a Toolkit – Users’ Guides and GRADE

Naming EBM was one thing. Making it useful at the bedside was another. The Users’ Guides to the Medical Literature gave clinicians a practical way to ask whether a study was valid, understand the results, and decide whether they applied to the patient in front of them. What problem were you trying to solve with the Users’ Guides?

Then came GRADE. By around 2000, multiple systems for rating evidence and recommendations made things confusing. GRADE separated certainty of evidence from strength of recommendation and made values, preferences, benefits, harms, and other considerations explicit. What were the older systems getting wrong that GRADE was trying to fix?

Question 4: Has EBM Been Hijacked?

EBM has received plenty of criticism over the years. Critics have called it cookbook medicine, overly reductionist, too focused on randomized trials, dismissive of mechanistic reasoning and clinical expertise, insufficiently attentive to individual patients, and vulnerable to industry or institutional influence. Some people also use the phrase “evidence-based” almost to end an argument. Which of those criticisms do you think are fair?

I want to push on one distinction that matters to skeptics. There is a difference between EBM as a way of thinking and an evidence-based guideline that gets handed to a clinician as a rule. When does a guideline become a GODline?

Question 5: The Future of Evidence-Based Medicine

Let’s fast-forward 30 years. It’s 2056, and EBM is more than 60 years old. What does it look like?

We’re already getting to a point where the clinician may not personally retrieve and critically appraise the paper. AI may find the literature, summarize it, assess certainty, and perhaps even generate a recommendation at the bedside. Does that make the core skills of EBM more important or less important?

The SGEM will be back next episode doing what we usually do—a structured critical appraisal of a recent publication as we continue trying to shorten the knowledge-translation window from more than ten years to less than one year using the power of social media.