Evidence and clinical judgement

Widespread acceptance of the neologism 'evidence-based medicine' (EBM) has had the consequences of obscuring what evidence really is, and of eroding the importance of judgement in clinical situations. In this essay I seek to correct this lack of balance in the view of clinical encounters as portrayed by EBM. A better understanding of what evidence is can be obtained by looking beyond medicine to the way in which scientists and detectives view evidence. In both spheres, the importance of judgement is emphasized, even if it is a technical type of judgement. Clinicians also employ a technical kind of judgement, similar to that in science and detective work, when assessing the evidence relating to the truth of a diagnosis for an individual patient; but judgements relating to the ongoing care and treatment of that patient are based on what Aristotle calls phronesis or 'practical wisdom'.