Professional judgement in clinical practice (part 2): knowledge into practice

Area of Science:

• Philosophy of Science
• Medical Epistemology
• Complexity Theory

Background:

• Strong evidence-based medicine (EBM) faces criticism for an insufficient theoretical basis.
• Its adherence to positivism hinders adoption of emergent scientific approaches like complexity theory.
• This resistance mirrors historical scientific paradigms that became untenable through excessive modification.

Purpose of the Study:

• To critically analyze the theoretical underpinnings and practical applications of strong EBM.
• To question EBM's claims of providing the sole valid approach to medical knowledge and action.
• To examine EBM's assertion of direct transferability of research findings to clinical practice.

Main Methods:

• Narrative Review.
• Critical analysis of EBM's epistemological foundations.
• Examination of EBM's application in clinical settings and ethical considerations.

Main Results:

• Strong EBM exhibits epistemological confusion, perpetuating outdated positivistic traditions.
• The hierarchy of evidence in EBM, particularly the emphasis on RCTs, inadequately accounts for clinical utility and decision-making.
• EBM's normative claims regarding research and clinical ethics are challenged.

Conclusions:

• Strong EBM's rigid framework resists necessary paradigm shifts in medical science.
• Its approach to evidence evaluation and application is insufficient for complex clinical realities.
• EBM's limitations extend to its ethical guidelines for researchers and clinicians.