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Theoretical Medicine and Bioethics

, Volume 30, Issue 3, pp 181–198 | Cite as

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

  • Hillel D. BraudeEmail author
Article

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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Copyright information

© Springer Science+Business Media B.V. 2009

Authors and Affiliations

  1. 1.Biomedical Ethics UnitMcGill UniversityMontrealCanada

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