Question: One frustration or perhaps lack of knowing is why the Medical Directives differ so much from province to province even for PCPs. Does "evidence based medicine" stop at provincial borders or is it that interpretation and application of such depends more on who, as well as financial politics and liabilities more than evidence based medicine and timely patient care? I can provide examples but I do not think it is specifically necessary-helpful per say in answering the primary question. Look forward to your response.

This is a very good question. Evidence Based Medicine does not stop at provincial borders. However, your question assumes that there is one correct, universal, answer to every situation and what is called Evidence Based Medicine is able to provide it. If this was true, then it follows that the directives in different provinces should be the same. However, this is not the way it is. Medical Directives are developed through a social process that takes into account many bits of evidence. You mentioned some of the other factors that affect how policy is made, such as finances, past practices, individual beliefs, etc. Each province is different and each time a medical directive is made these factors come into play. Even at a Base Hospital level, there can be multiple interpretations of the same directive. It is frustrating to see different things being done in different places, especially when you disagree with what is being done. There is no simple solution, nor is it likely possible to change the fact that Medical Directives will be different in different places. That is the nature of how policy is made. However, Medical Directives do change, all the time, as new information becomes available.

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