Parker M
School of Medicine UQ, Herston Rd, Herston, Qld 4006, Australia.
Med Humanit. 2005 Jun;31(1):23-30. doi: 10.1136/jmh.2004.000195.
According to numerous commentators, clinical freedom, the art of medicine, and, by implication, a degree of patient welfare, are threatened by evidence based medicine (EBM). As EBM has developed over the last fifteen years, claims about better evidence for medical treatments, and improvements in healthcare delivery, have been matched by critiques of EBM's reductionism and uniformity, its problematic application to individual patients, and its alleged denial of the continuing need for clinical interpretation, insight, and judgment. Most of these attacks on EBM and defences of clinical freedom fail. They are based on erroneous understandings of the relationships between inductive knowledge, clinical uncertainty, and action. Evidence based medicine is a necessary condition for clinical freedom, not a threat to it, and EBM is not something to be balanced with either clinical experience or patient preferences. The art and science of medicine are more conceptually and practically connected than the defenders of clinical freedom, whatever they conceive that to be, are willing to admit.
众多评论家认为，临床自主性、医学技艺，以及由此暗示的一定程度的患者福祉，正受到循证医学（EBM）的威胁。在过去十五年循证医学的发展过程中，关于医疗治疗有更好证据以及医疗服务有所改善的说法，与对循证医学的还原论和统一性、其在个体患者身上的应用问题，以及其所谓否定临床解读、洞察力和判断力持续需求的批评相呼应。大多数对循证医学的这些攻击以及对临床自主性的辩护都是失败的。它们基于对归纳知识、临床不确定性和行动之间关系的错误理解。循证医学是临床自主性的必要条件，而非对其的威胁，并且循证医学并非要与临床经验或患者偏好相平衡。医学的技艺与科学在概念和实践上的联系，比临床自主性的捍卫者（无论他们如何理解临床自主性）愿意承认的更为紧密。
