Outdated approach to a common problem.

Dr Ladouceur appeals for a return to artful care, in which evidence does not interfere with clinical judgment. I remind Dr Ladouceur that evidence-based care occurs at the intersecting triad of clinician judgment, best available evidence, and patient values and preferences, all of which underlie the shared decision-making paradigm.22 In mourning the loss of a pointless and potentially harmful routine examination, despite clear values and preferences expressed by women and evidence that it would harm but not benefit women, Dr Ladouceur is not making the case for clinical judgment versus evidence. Rather he has made a case for his personal judgment, which does not appear to be shared by patients or by guideline panels in Canada and the United States. —Ainsley Moore MD MSc(HB) CCFP Hamilton, Ont