Clinical intuition versus statistics: Different modes of tacit knowledge in clinical epidemiology and evidence-based medicine
Theoretical Medicine and Bioethics 30 (3):181-198 (2009)
AbstractDespite its phenomenal success since its inception in the early nineteen-nineties, the evidence-based medicine movement has not succeeded in shaking off an epistemological critique derived from the experiential or tacit dimensions of clinical reasoning about particular individuals. This critique claims that the evidence-based medicine model does not take account of tacit knowing as developed by the philosopher Michael Polanyi. However, the epistemology of evidence-based medicine is premised on the elimination of the tacit dimension from clinical judgment. This is demonstrated through analyzing the dichotomy between clinical and statistical intuition in evidence-based medicine’s epistemology of clinical reasoning. I argue that clinical epidemiology presents a more nuanced epistemological model for the application of statistical epidemiology to the clinical context. Polanyi’s theory of tacit knowing is compatible with the model of clinical reasoning associated with clinical epidemiology, but not evidence-based medicine.
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References found in this work
Judgment Under Uncertainty: Heuristics and Biases.Daniel Kahneman, Paul Slovic & Amos Tversky (eds.) - 1982 - Cambridge University Press.
Judgment Under Uncertainty: Heuristics and Biases.Amos Tversky & Daniel Kahneman - 1974 - Science 185 (4157):1124-1131.
Personal Knowledge: Towards a Post-Critical Philosophy.Michael Polanyi - 1958 - University of Chicago Press.
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Citations of this work
Mechanisms: What Are They Evidence for in Evidence-Based Medicine?Holly Andersen - 2012 - Journal of Evaluation in Clinical Practice 18 (5):992-999.
Polanyi's Tacit Knowing and the Relevance of Epistemology to Clinical Medicine.Stephen G. Henry - 2010 - Journal of Evaluation in Clinical Practice 16 (2):292-297.
A Social-Technological Epistemology of Clinical Decision-Making as Mediated by Imaging.Sophie van Baalen, Annamaria Carusi, Ian Sabroe & David G. Kiely - 2017 - Journal of Evaluation in Clinical Practice 23 (5):949-958.
An Integrated Model of Clinical Reasoning: Dual‐Process Theory of Cognition and Metacognition.James A. Marcum - 2012 - Journal of Evaluation in Clinical Practice 18 (5):954-961.
Evidence‐Based Medicine's Curious Path: From Clinical Epidemiology to Patient‐Centered Care Through Decision Analysis.Paul R. Falzer - 2021 - Journal of Evaluation in Clinical Practice 27 (3):631-637.
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