Dr Adam Cifu, a practising general internist in Chicago, joins us to discuss how medical practices previously adopted are later found out to be ineffective or harmful. Why does this reversal occur? How can we make better decisions for patients given what evidence is available and how should doctors approach uncertainty? We talk about some of the disconnect between the medical literature and a patient sitting in front of a clinician, as well as what can be done to both improve the evidence that doctors and patients use to make decisions and this decision-making process.