Lawrie et al (Reference Lawrie, Scott and Sharpe2001) have touched upon the core problem of evidence-based psychiatry by raising the most relevant questions. Although the evidence-based medicine movement began in 1992 (Reference Sackett, Straus and RichardsonSackett et al, 2000), it was not until the Royal College of Psychiatrists introduced a Critical Review Paper to the MRCPsych Part II examination in 1999 that clinicians suddenly realised the problems of not knowing enough about critical appraisal of scientific papers.

Brown & Wilkinson (Reference Brown and Wilkinson2000) assert, “Psychiatrists should be able to evaluate published literature both in terms of its scientific validity and its clinical relevance”. Why — to be able to practise evidence-based psychiatry, or to help trainees pass their exam? In a Scottish survey Lawrie et al (Reference Lawrie, Scott and Sharpe2000) discovered that senior psychiatrists found the time required to search and appraise the literature as the greatest barrier to practising evidence-based psychiatry. Would they be able to practise better if they had enough time, for instance 60 minutes per day? I do not know how to search for the best evidence to answer this question. I have recently read the recommended books (Reference Brown and WilkinsonBrown & Wilkinson, 2000; Reference Sackett, Straus and RichardsonSackett et al, 2000), and I have also attended a few evidence-based medicine workshops. When my patients and trainees ask real-life clinical questions, I often get lost. Is this the beginning of my ageing-related cognitive impairment? Or is it just because I am such a busy clinician that I do not have time and need to take evidence-based psychiatry seriously? But how can we help our trainees? What about our own revalidation? We cannot really fudge the issue any more if we want to remain effective trainers.

Lawrie et al (Reference Lawrie, Scott and Sharpe2001) have raised the question, ‘Whose responsibility?’ Clinicians intimidated by the practical concepts of evidence-based psychiatry need to respond by expressing their difficulties and asking for time and resources to guide them through its complexities. Easy access to summaries of evidence may be the shortterm solution, but the science of evidence-based psychiatry has to be mastered to continue practising the art of medicine. It's our responsibility.