Hauswaldt Johannes
Institut für Allgemeinmedizin, Medizinische Hochschule Hannover, Hannover.
Z Evid Fortbild Qual Gesundhwes. 2010;104(8-9):625-9. doi: 10.1016/j.zefq.2010.09.022. Epub 2010 Oct 12.
The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence. Strange enough, scientific discussion focuses on external evidence from systematic research, but neglects its counterpart, i.e., individual clinical expertise. Apart from a lack of appropriate intellectual tools for approaching the latter, this might be due to the mutual concealment of thought and action, of sensor and motor activity (Viktor von Weizsaecker's principle of the revolving door). Behind this, and incommensurably different from each other, lie the world of physics and the world of biology with an ego animal, that is, the dilemma of the self-conscious subject in a world of objects. When practicing medicine, this dilemma of self-reference is being resolved but only through a holistic approach combining rational and external evidence with biographical, spiritual, emotional and pre-rational elements represented in the physician's individual clinical expertise.
循证医学的实践意味着将个人临床专业知识与可获得的最佳外部临床证据相结合。奇怪的是,科学讨论聚焦于系统研究的外部证据,却忽视了其对应物,即个人临床专业知识。除了缺乏处理后者的适当智力工具外,这可能是由于思维与行动、感觉与运动活动的相互隐匿(维克托·冯·魏茨泽克的旋转门原理)。在这背后,彼此差异巨大的是物理学世界和有自我意识的动物的生物学世界,也就是说,是自我意识主体在客体世界中的困境。行医时,这种自我指涉的困境只有通过将理性和外部证据与医生个人临床专业知识中所体现的传记、精神、情感和前理性元素相结合的整体方法才能得到解决。