[Evidence-based medicine as a model of decision making in clinical practice]

The way how we apply the principles of evidence-based medicine in the real clinical world is based on a number of implicitly assumed theoretical models. The aim of the present article is to identify these theories and use their impact to explain their importance for the application of evidence-based medicine.

Philosophical theories were analysed with regard to their impact on the present investigation, i.e. their ability to explain the implicit theoretical background to this way of practising evidence-based medicine. In a second step, the theories identified were used to discuss the question of clinical decision making. The model of the hermeneutic approach to clinical casework was used to introduce a strategy for everyday application of evidence-based medicine in the clinical field.

In the context of these theories, there are three archetypal models of clinical decision making. These include the intuitive, the hypothesis-based and the evidence-based approach. In this sense, evidence-based medicine is a hermeneutic model for making clinical decisions. The mean impact of evidence-based medicine is the introduction of the best external evidence as a basis of the hermeneutic clinical casework. In the model of the "best external evidence", the clinician experiences a great change in clinical decision making. This change is generated by crossing the border from applying scientific clinical hypotheses to systematically identified and reviewed results of high-quality research work. In this sense, hermeneutic casework demonstrates that there is a contradictory unity between evidence-based clinical data and the clinician's understanding of a clinical case--a contradiction that may only be solved by the clinician's internal evidence.