Abstract: Qualitative Evidence Synthesis is located where two paradigms collide. On the one hand the imprint of the systematic review of effects is so securely imposed that it is difficult to challenge its pervasive influence. On the other hand, surely qualitative synthesis should be shaped by the same epistemological assumptions that underpin primary qualitative research. This presentation traces the contrasting contributions of these two influences through recent methodological developments within qualitative evidence synthesis as manifest at the various stages of the systematic review process. Are PICO-based derivatives appropriate when formulating questions for qualitative review? To what extent does the model of the comprehensive exhaustive literature search face challenges from purposive and iterative sampling approaches? Should qualitative research face the equivalent of the Cochrane Risk of Bias assessment? Are the objectives of quantitative and qualitative synthesis fundamentally opposed? Are reporting standards appropriate for qualitative research and syntheses? Initiatives such as GRADE-CERQual and increasing interest in mixed-methods reviews suggest potential ways forward in reconciling the two paradigms. Leave or remain – let the people decide!