Clinical intuition versus statistics: Different modes of tacit knowledge in clinical epidemiology and evidence-based medicine

Theoretical Medicine and Bioethics 30 (3):181-198 (2009)

Abstract
Despite its phenomenal success since its inception in the early nineteen-nineties, the evidence-based medicine movement has not succeeded in shaking off an epistemological critique derived from the experiential or tacit dimensions of clinical reasoning about particular individuals. This critique claims that the evidence-based medicine model does not take account of tacit knowing as developed by the philosopher Michael Polanyi. However, the epistemology of evidence-based medicine is premised on the elimination of the tacit dimension from clinical judgment. This is demonstrated through analyzing the dichotomy between clinical and statistical intuition in evidence-based medicine’s epistemology of clinical reasoning. I argue that clinical epidemiology presents a more nuanced epistemological model for the application of statistical epidemiology to the clinical context. Polanyi’s theory of tacit knowing is compatible with the model of clinical reasoning associated with clinical epidemiology, but not evidence-based medicine.
Keywords Clinical reasoning  Clinical epidemiology  Evidence-based medicine  Epistemology  Intuition  Randomization  Statistics  Tacit knowing
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DOI 10.1007/s11017-009-9106-4
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References found in this work BETA

Recognizing Tacit Knowledge in Medical Epistemology.Stephen G. Henry - 2006 - Theoretical Medicine and Bioethics 27 (3):187--213.

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Mechanisms: What Are They Evidence for in Evidence-Based Medicine?Holly Andersen - 2012 - Journal of Evaluation in Clinical Practice 18 (5):992-999.
Clinical Judgement: Multidisciplinary Perspectives.Benjamin Chin-Yee & Jonathan Fuller - 2018 - Journal of Evaluation in Clinical Practice 24 (3):635-637.
Polanyi's Tacit Knowing and the Relevance of Epistemology to Clinical Medicine.Stephen G. Henry - 2010 - Journal of Evaluation in Clinical Practice 16 (2):292-297.

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