A lack of implementation of evidence-based care involves both commission and omission at the level of the physician and institution. Changing physician behavior, especially in nonacademic environments, is particularly challenging, and no single method, even in an optimal environment, has ensured its success. The major limitations have been the cost- and labor-intensive nature of these practices. In addition, although aggressive intervention has been shown to lead to an increase in knowledge and temporary change, there is little documentation that persistence in change in clinical practice occurs. Currently, 3 techniques are thought to be most effective and have been used in various settings via a multifaceted intervention program (combining 2 or more of the intervention mechanisms), including data collection on the use of EBM guidelines and direct feedback of results to individual practitioners; academic detailing (in which an expert visits physicians individually to provide objective information on a particular topic in brief educational sessions); and reminders or prompting through electronic medical record flags, mass institutional mailings, and other mechanisms.43 To create an environment of easy access and ongoing site of practice education to help maintain practice change, linkages for personal digital assistants, and other direct-link electronic medical record constructs are being developed to link EBM to the ongoing care of an individual patient.46 Elimination of the need for proactive searches for evidence and replacement by automatic passive linkage to EBM in patient clinical site electronic medical records might overcome a large portion of physician resistance by minimizing time and effort requirements. However, although demonstrated to be effective in varying scenarios, none of these interventions has been uniformly evaluated in a significant number of surgical specialist settings, and the overall effectiveness is far from conclusive. It is entirely possible that the efficacy of any of these approaches may vary with the patient disease, the culture of the providers, and the clinical setting. Until these variables and the effectiveness have been established in the unique setting of each of these confounding variables, there will be a need for continuing evolution of mechanisms to optimize change in physician behavior in response to evidence-based patient care. With the explosion of knowledge and the ongoing variability of the EBM results, highly filtered and regulated systems are needed to provide succinct, current, and thoroughly objective EBM summaries for clinician assimilation. In addition, well-controlled, prospective studies in the various institutional (academic vs community) settings and in each of the surgical specialties are required to ensure that optimal approaches are chosen for this potentially very expensive process of behavior modification. It is imperative that surgeons take a lead, not only in the generation of data testing clinical care, but also in accepting and implementing appropriate new guidelines: in addition to helping their patients, they can serve as role models for all physicians. Surgeons have a tradition of adopting new approaches and techniques to improve care, and implementing EBM is yet one more goal.