In the application of medical knowledge—both in clinical practice and in political decision-making—the concept of evidence-based medicine (EBM) has assumed a dominant position over the last 30 years. EBM sees itself on the one hand as a movement against traditional medical decision-making structures, while on the other hand it is a method that provides certain procedures (evidence pyramid, GRADE system [grading of recommendations assessment, development and evaluation]) on the basis of various criteria (randomized controlled trials [RCTs], meta-analyses as the highest levels of evidence) in order to facilitate decision-making in medicine. In view of the complexity of medical knowledge, such procedures are urgently needed and a reason for the great success of EBM. The reduction of complexity to a handful of criteria, however, has its limits and produces problems. Dealing with these is one of the challenges that EBM has had to face since its inception. The author argues that there is a need to understand that human judgment (e.g. in the form of consensus, as well as in the form of making dissent transparent) cannot be excluded from medical decision-making. Human judgements—whether made by individuals or in groups—are fallible for a variety of reasons (error, ignorance, conflicts of interest, claims to power)—but they cannot be eliminated by ignoring them or by believing that the responsibility arising from them can be completely transferred to procedures or algorithms. The first part of the article places EBM in its historical context. In the second section, the hierarchy of evidence is critically discussed and its limits shown using the pyramid of evidence and the GRADE procedure. In the last part, two examples—the evidence of the EBM’s methods and the consensus conferences in the development of guidelines—highlight the importance of human judgement.