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Reflexivity and metapositions: strategies for appraisal of clinical evidence
Author(s) -
Malterud Kirsti
Publication year - 2002
Publication title -
journal of evaluation in clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.737
H-Index - 73
eISSN - 1365-2753
pISSN - 1356-1294
DOI - 10.1046/j.1365-2753.2002.00353.x
Subject(s) - reflexivity , presumption , situated , set (abstract data type) , evidence based medicine , casual , psychology , interpretation (philosophy) , critical appraisal , rhetorical question , epistemology , quality (philosophy) , elaboration , social psychology , cognitive psychology , medicine , sociology , alternative medicine , computer science , political science , social science , linguistics , philosophy , pathology , artificial intelligence , law , programming language , humanities
According to Sackett, evidence‐based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. In this article, clinical reasoning is depicted as multilayered processes of evidence construction by means of social interaction and human interpretation. A basic set of knowledge is the doctor’s initial capital at the onset of the individual encounter. This is a necessary, but insufficient, presumption for the elaboration of clinical knowledge required to solve the particular problem. A diagnostic conclusion may appear to constitute the most obvious part of knowledge. Yet the formulation of hypotheses and the choice of adequate strategies for the pursuit of evidence are perhaps even more significant dimensions of clinical knowledge. Potential biases affect the ways in which evidence is gathered and used. When clinicians are not committed to appraising the evidence constituting the foundations of their enterprise, quality assessment of clinical practice becomes casual and unreliable. Reflexivity implies having a self‐conscious account of the production of knowledge as it is being produced. From metapositions, critical questions can be asked and sometimes answered. Evidence‐based practice in the original sense requires that doctors reflect upon their own positions as knowers, in the process of situated knowing, where certain rhetorical spaces rule.