Siebolds Marcus
Katholische Fachhochschule Nordrhein Westfalen, Abt. Köln, Fachbereich Gesundheitswesen.
Z Arztl Fortbild Qualitatssich. 2003 Jul;97(4-5):257-62.
The way how we apply the principles of evidence-based medicine in the real clinical world is based on a number of implicitly assumed theoretical models. The aim of the present article is to identify these theories and use their impact to explain their importance for the application of evidence-based medicine.
Philosophical theories were analysed with regard to their impact on the present investigation, i.e. their ability to explain the implicit theoretical background to this way of practising evidence-based medicine. In a second step, the theories identified were used to discuss the question of clinical decision making. The model of the hermeneutic approach to clinical casework was used to introduce a strategy for everyday application of evidence-based medicine in the clinical field.
In the context of these theories, there are three archetypal models of clinical decision making. These include the intuitive, the hypothesis-based and the evidence-based approach. In this sense, evidence-based medicine is a hermeneutic model for making clinical decisions. The mean impact of evidence-based medicine is the introduction of the best external evidence as a basis of the hermeneutic clinical casework. In the model of the "best external evidence", the clinician experiences a great change in clinical decision making. This change is generated by crossing the border from applying scientific clinical hypotheses to systematically identified and reviewed results of high-quality research work. In this sense, hermeneutic casework demonstrates that there is a contradictory unity between evidence-based clinical data and the clinician's understanding of a clinical case--a contradiction that may only be solved by the clinician's internal evidence.
我们在实际临床环境中应用循证医学原则的方式基于一些隐含假设的理论模型。本文的目的是识别这些理论，并利用它们的影响来解释其对循证医学应用的重要性。
分析哲学理论对本研究的影响，即其解释循证医学这种实践方式隐含理论背景的能力。第二步，用所识别的理论来讨论临床决策问题。采用临床案例工作的诠释学方法模型，介绍循证医学在临床领域日常应用的策略。
在这些理论背景下，存在三种临床决策的原型模型。这些包括直觉型、基于假设型和循证型方法。从这个意义上说，循证医学是一种临床决策的诠释学模型。循证医学的平均影响是引入最佳外部证据作为诠释学临床案例工作的基础。在“最佳外部证据”模型中，临床医生在临床决策中经历了巨大变化。这种变化是通过从应用科学临床假设跨越到系统识别和审查高质量研究工作的结果而产生的。从这个意义上说，诠释学案例工作表明循证临床数据与临床医生对临床案例的理解之间存在矛盾统一——这种矛盾可能只能通过临床医生的内部证据来解决。
