Evidence based medicine is always great but sadly when it comes to actual clinical practice it becomes eminence based medicine. Unless the eminent doctors take up evidence based practices it does not percolate to wider general level.

Fortunately, in the current era, there is no significant divergence between
evidence and eminence.
The issue becomes important in 2 areas.

Area 1. Evidence is relatively new and subject to change rapidly. It becomes perplexing when a study shows something effective once in an RCT may become ineffective in next RCT or meta-analysis.

This is typically being seen in emerging/evolving diseases or techniques. The evidence is so dynamic that the speed of practical implementation is difficult.

Area2 : When it involves paradigm change in years of what was routine.
E.g. laparoscopy vs open

Neoadjuvant Vs standard

Hence whenever these 2 areas are involved there is going to be disagreements/ divergence of opinions and when somebody picks these arbitrarily and claims that see 'how modern medicine is bad they are self contradictory' it doesn't make sense. Why let's see.

Most previous practices are time tested, they are there because they worked. So when a better method replaces it, it doesn't make it obsolete immediately. And obsolete doesn't always translate to harmful.

More intense arguments are on methods where there is something of marginal benefit but no much harm.
Here obtaining a consensus is most difficult.

Then what's done. A panel or working group of experts sits and finds out the subset where this benefit can be maximal.
They know they might prove themselves wrong also with their own results.