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Evidence and clinical judgement

R J Macnaughton1

  • 1University of Glasgow Department of General Practice, Woodside Health Centre, UK.

Journal of Evaluation in Clinical Practice
|December 5, 1998
PubMed
Summary

Evidence-based medicine (EBM) has obscured the nature of evidence and devalued clinical judgment. This essay argues for a balanced view, integrating technical judgment with practical wisdom for better patient care.

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Area of Science:

  • Clinical decision-making
  • Philosophy of medicine
  • Medical ethics

Background:

  • The term 'evidence-based medicine' (EBM) is widely accepted.
  • EBM's prevalence has led to a diminished understanding of 'evidence' itself.
  • The importance of clinical judgment in patient care has been eroded.

Purpose of the Study:

  • To re-balance the perspective of clinical encounters presented by EBM.
  • To clarify the multifaceted nature of evidence in clinical practice.
  • To re-emphasize the role of judgment in medicine.

Main Methods:

  • Analysis of the concept of evidence beyond the medical field.
  • Comparison of evidence assessment in science and detective work.
  • Application of Aristotelian philosophy (phronesis) to clinical judgment.

Main Results:

  • Evidence assessment involves technical judgment, akin to science and detective work.
  • Diagnosis verification relies on this technical clinical judgment.
  • Ongoing patient care and treatment decisions necessitate practical wisdom (phronesis).

Conclusions:

  • A more comprehensive understanding of evidence requires looking beyond EBM.
  • Clinical judgment is crucial and has distinct components: technical assessment and practical wisdom.
  • Integrating practical wisdom is essential for effective and ethical patient care.

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