Experiential knowledge in clinical medicine: use and justification

Area of Science:

• Medical Practice
• Epistemology
• Clinical Decision-Making

Background:

• Evidence-based medicine (EBM) acknowledges clinical expertise but undervalues primary patient experience.
• Clinicians' firsthand experience is often dismissed as anecdotal or biased, rather than a source of valid knowledge.
• The EBM framework presents an epistemic inconsistency by valuing expertise while distrusting its experiential foundation.

Purpose of the Study:

• To advocate for the value and utility of knowledge derived from primary clinical experience.
• To challenge the dismissal of experiential knowledge within the evidence-based medicine paradigm.
• To highlight the distinct yet crucial role of experiential knowledge alongside propositional knowledge in patient care.

Main Methods:

• Philosophical argument and conceptual analysis.
• Critique of existing hierarchies of evidence in clinical decision-making.
• Examination of the relationship between propositional and experiential knowledge in medicine.

Main Results:

• Primary clinical experience provides essential knowledge for diagnosing, treating, and assessing patient responses.
• Hierarchies of evidence often misrepresent the interplay between propositional and experiential knowledge.
• Experiential knowledge is a distinct and vital form of medical knowledge.

Conclusions:

• Clinical expertise, rooted in primary experience, is indispensable for optimal medical practice.
• Experiential knowledge is as crucial as propositional knowledge from research for determining patient-specific diagnoses and treatments.
• Reintegrating the value of primary experience is necessary for a more coherent and effective approach to evidence-based medicine.