We examine the debate that has developed, in response to claims of the emergence of a "new paradigm" in medical practice. The paradigm, christened evidence-based medicine (EBM) by its developers at McMaster University in Canada, emphasises the need for more rigorous use of the findings and advice which flow from clinical research. This paper outlines the views published in the medical press on the relative merits of adopting an evidence-based approach to clinical decision-making. It then presents what we call "a view from the trenches " - the views and opinions of a sample of some 300 practising clinicians, in both primary and secondary care, with regard to evidence-based medicine. A number of the reservations about evidence-based medicine, as expressed both in print and in the course of our interviews, are examined from the perspective of the management of change literature. In so doing, it highlights a number of barriers to the diffusion of a new paradigm and suggests possible strategies for overcoming them.