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Integrating evidence into clinical practice: an alternative to evidence‐based approaches
Author(s) -
Tonelli Mark R.
Publication year - 2006
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 - 10.1111/j.1365-2753.2004.00551.x
Subject(s) - empirical evidence , evidence based medicine , action (physics) , medicine , value (mathematics) , clinical practice , experiential knowledge , clinical judgment , experiential learning , clinical decision making , psychology , management science , epistemology , alternative medicine , intensive care medicine , computer science , nursing , medical physics , philosophy , physics , mathematics education , pathology , quantum mechanics , machine learning , economics
Evidence‐based medicine (EBM) has thus far failed to adequately account for the appropriate incorporation of other potential warrants for medical decision making into clinical practice. In particular, EBM has struggled with the value and integration of other kinds of medical knowledge, such as those derived from clinical experience or based on pathophysiologic rationale. The general priority given to empirical evidence derived from clinical research in all EBM approaches is not epistemically tenable. A casuistic alternative to EBM approaches recognizes that five distinct topics, 1) empirical evidence, 2) experiential evidence, 3) pathophysiologic rationale, 4) patient goals and values, and 5) system features are potentially relevant to any clinical decision. No single topic has a general priority over any other and the relative importance of a topic will depend upon the circumstances of the particular case. The skilled clinician must weigh these potentially conflicting evidentiary and non‐evidentiary warrants for action, employing both practical and theoretical reasoning, in order to arrive at the best choice for an individual patient.