Physiatrists as expert decision makers or understanding the efficiency bashing mismanagement of evidence-based medicine

The practice of inpatient rehabilitation addresses the extensive and complex needs of a very small but needy percent of the overall population. This uniqueness makes most physiatric inpatients outliers relative to the best evidence-based medicine practices. Evidence-based medicine studies focus on simple one problem issues averaged statistically over the entire population or a representative sample. Our inpatients rarely have one problem, and often the multiplicity of problems means contradictory guidance to care. To care for these patients efficiently, feedback to optimize and individualize care is necessary. To try to make all patients fit simplistic evidence-based medicine care paths without individualization leads to less cost-efficient and at times harmful care.