Introduction

How surgeons make decisions affects the immediate and long-term outcomes of care of our patients. Such decisions will also, in the near future, affect our reimbursement, our referral patterns, and possibly our privileges to perform certain operations. Most of the decisions that we currently make in our surgical practices are insufficiently grounded in adequate evidence. In addition, we tend to ignore published evidence and guidelines, preferring to base our decisions on prior training, anecdotal experience, and intuition as to what is best for an individual patient. Improving the process of decision making is vital to our patients’ welfare, to the health of our specialty, and to our own careers. To do this we must thoughtfully embrace the culture of Evidence based medicine. This requires critical appraisal of reported evidence, interpretation of the evidence with regards to the target population, integration of appropriate information and guidelines into daily practice, and wise use of new information technologies. Constant review of practice patterns, updating management algorithms, and critical assessment of results is necessary to maintain optimal quality care. Unless individual surgeons adopt leadership roles in this process and thoracic surgeons as a group buy into this concept, we will find ourselves marginalized by outside forces that will distance us from our patients and discount our expertise in making vital decisions.