David Bourget (Western Ontario)
David Chalmers (ANU, NYU)
Rafael De Clercq
Jack Alan Reynolds
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Theoretical Medicine and Bioethics 27 (3):187--213 (2006)
The evidence-based medicine movement advocates basing all medical decisions on certain types of quantitative research data and has stimulated protracted controversy and debate since its inception. Evidence-based medicine presupposes an inaccurate and deficient view of medical knowledge. Michael Polanyi’s theory of tacit knowledge both explains this deficiency and suggests remedies for it. Polanyi shows how all explicit human knowledge depends on a wealth of tacit knowledge which accrues from experience and is essential for problem solving. Edmund Pellegrino’s classic treatment of clinical judgment is examined, and a Polanyian critique of this position demonstrates that tacit knowledge is necessary for understanding how clinical judgment and medical decisions involve persons. An adequate medical epistemology requires much more qualitative research relevant to the clinical encounter and medical decision making than is currently being done. This research is necessary for preventing an uncritical application of evidence-based medicine by health care managers that erodes good clinical practice. Polanyi’s epistemology shows the need for this work and provides the structural core for building an adequate and robust medical epistemology that moves beyond evidence-based medicine.
|Keywords||clinical judgment medical epistemology evidence-based medicine Edmund Pellegrino Michael Polanyi tacit knowledge|
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References found in this work BETA
Eric J. Cassell (2004). The Nature of Suffering and the Goals of Medicine. Oxford University Press.
Michael Polanyi (1967). The Tacit Dimension. London, Routledge & K. Paul.
Edmund D. Pellegrino (1993). The Virtues in Medical Practice. Oxford University Press.
Gerd Gigerenzer (1989). The Empire of Chance How Probability Changed Science and Everyday Life. Monograph Collection (Matt - Pseudo).
Michael Polanyi (1975). Meaning. University of Chicago Press.
Citations of this work BETA
Andrew Miles, Michael Loughlin & Andreas Polychronis (2008). Evidence‐Based Healthcare, Clinical Knowledge and the Rise of Personalised Medicine. Journal of Evaluation in Clinical Practice 14 (5):621-649.
Stephen G. Henry (2010). Polanyi's Tacit Knowing and the Relevance of Epistemology to Clinical Medicine. Journal of Evaluation in Clinical Practice 16 (2):292-297.
Mark R. Tonelli (2010). The Challenge of Evidence in Clinical Medicine. Journal of Evaluation in Clinical Practice 16 (2):384-389.
Hillel D. Braude (2011). Tacit Clues and the Science of Clinical Judgement [a Commentary on Henry Et Al.]. Journal of Evaluation in Clinical Practice 17 (5):940-943.
Stephen G. Henry, Jane H. Forman & Michael D. Fetters (2011). 'How Do You Know What Aunt Martha Looks Like?' A Video Elicitation Study Exploring Tacit Clues in Doctor–Patient Interactions. Journal of Evaluation in Clinical Practice 17 (5):933-939.
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