Hypocognition and evidence-based medicine

The enthusiasm for evidence-based medicine (EBM) has not been accompanied by the same success in bridging the gap between theory and practice. This paper advances the hypothesis that the phenomenon psychologists call hypocognition may hinder the development of EBM. People tend to respond to frames rather than to facts. To be accepted, a theory, however robust, must fit into a person's mental framework. The absence of a simple, consolidated framework is referred to as hypocognition. Hypocognition might limit the application of EBM in three ways. First, it fails to provide an analytical framework by which to orient the physician in the direction of continuous medical development and variability in individual people's responses. Second, little emphasis is placed on teaching clinical reasoning. Third, there is an imbalance between the enormous mass of available information and the practical possibilities. Possible solutions are described. We not only need more evidence to help clinicians make better decisions, but also need more research on why some clinicians make better decisions than others, how to teach clinical reasoning, and whether computerised supports can promote a higher quality of individualised care.