A careless shoe-string, in whose tieI see a wild civility:Do more bewitch me, than when artIs too precise in every part. “Delight in Disorder,” Robert Herrick (1591–1674)

Herrick's 17th-century sonnet seems the antithesis of the scientific movement toward evidence-based medicine. And, of course, it mostly is: there is no place for the “careless” or the “wild.” Yet those of us who still exalt in the “art” of medicine are less “bewitched” when guidance becomes “too precise in every part.” This is a subversive sentiment and, if applied to our patients, must be done so thoughtfully and responsibly. However, it may lead us to a useful insight: evidence-based medicine is not incompatible with significant practice variation.

In this month's issue of Pediatrics, Goldman et al describe (with a perceptible sense of dismay) practice variation across Canadian pediatric emergency departments in the management of febrile infants younger...

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