Clinical intuition versus statistics: different modes of tacit knowledge in clinical epidemiology and evidence-based medicine |
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| Authors: | Hillel D Braude |
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| Institution: | (1) Biomedical Ethics Unit, McGill University, 3647 Peel Street, Montreal, QC, H3A 1X1, Canada |
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| 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.
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| Keywords: | Clinical reasoning Clinical epidemiology Evidence-based medicine Epistemology Intuition Randomization Statistics Tacit knowing |
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