Djulbegovic B, Morris L, Lyman G H
Department of Internal Medicine, H Lee Moffitt Cancer Center & Research Institute, University of South Florida, Tampa 33612-9497, USA.
J Eval Clin Pract. 2000 May;6(2):99-109. doi: 10.1046/j.1365-2753.2000.00226.x.
The evidence-based medicine (EBM) movement has exerted a strong influence on contemporary medicine. It has been used to define the hierarchy of knowledge in clinical medicine by classifying clinical findings according to the perceived relevance and validity of the respective methodologies of studies from which evidence was collected. In the spectrum of theories of knowledge, EBM predominantly relies on findings obtained from population-derived clinical research. This reliance on knowledge obtained from population studies sharply contrasts with a physiologic model of clinical knowledge advocated by basic science researchers and many clinicians. An apparent schism between proponents of physiologic and population models in the approach to the practice of medicine has been created. This dichotomy between practising physicians and EBM physicians in the approach to clinical knowledge should not be irreconcilable. We advocate a consilient approach to the interpretation of evidence and the integration of medical knowledge. This approach relies on 'linking of facts and fact-based theory across various disciplines to create a common groundwork of explanation'.
循证医学运动对当代医学产生了重大影响。它被用于通过根据收集证据的各项研究方法的感知相关性和有效性对临床发现进行分类，来界定临床医学中的知识层次。在知识理论的范畴内，循证医学主要依赖于从人群临床研究中获得的发现。这种对人群研究所得知识的依赖，与基础科学研究者和许多临床医生所倡导的临床知识生理学模型形成了鲜明对比。在医学实践方法上，生理学模型和人群模型的支持者之间出现了明显的分歧。临床医生和循证医学医生在临床知识获取方法上的这种二分法不应是不可调和的。我们提倡一种将证据解读与医学知识整合相结合的统一方法。这种方法依赖于“跨学科地将事实与基于事实的理论联系起来，以创建一个共同的解释基础”。
