Abstract

Despite the innovation that evidence-based medicine (henceforth EBM) represents for biomedical sciences today, we argue that its strict evidential hierarchies do not faithfully represent the epistemic and practical reality of the evidence that should be used to make appropriate clinical decisions. We defend that it is necessary to make modifications to the methodology and models of clinical decision-making proposed by EBM and make them more sensitive to the use of different types of evidence and reasoning. Since various types of evidence and reasoning, and medical expertise still play an irreducible role in clinical decision-making, rather than continuing with their strict hierarchies, we argue that those who subscribe to the EBM paradigm should discuss in much greater detail different types of evidence and reasoning. Admitting and advocating the role of other types of evidence and reasoning in clinical decision-making will also be necessary to introduce other types of inference and evaluation, as this generates conclusions that do not rely solely on induction or deduction. Both clinical judgment and the clinical eye play a prominent role in this context, particularly in diagnosis, as uncertainty inherently influences the process. If we hit the nail on the head, effective EBM practice requires other types of reasoning beyond biostatistical reasoning. With this in mind, we characterize clinical judgment based on abductive inference.