Evidence based medicine (EBM) appeared early in the 1990s and since then it has been developed and expanded worldwide. A decade later we summarize the history of EBM, the initial debates and the evolution to the current concept of evidence based health care (EBHC) as a tool for clinical decision making. We also describe the process of EBHC, some insights to current dilemmas and the situation of EBM in Chile (Rev Méd Chile 2003; 131: 939-46)