De Freitas Julian, Haque Omar S, Gopal Abilash A, Bursztajn Harold J
Department of Psychology at Yale University, New Haven, Connecticut, USA.
J Clin Ethics. 2012 Spring;23(1):28-36.
A long-debated question in the philosophy of health, and contingent disciplines, is the extent to which wise clinical practice ("clinical wisdom") is, or could be, compatible with empirically validated medicine ("evidence-based medicine"--EBM). Here we respond to Baum-Baicker and Sisti, who not only suggest that these two types of knowledge are divided due to their differing sources, but also that EBM can sometimes even hurt wise clinical practice. We argue that the distinction between EBM and clinical wisdom is poorly defined, unsupported by the methodology employed, and ultimately incorrect; crucial differences exist, we argue, not in the source of a particular piece of clinical knowledge, but in its dependability. In light of this subtle but fundamental revision, we explain how clinical wisdom and EBM are--by necessity--complementary, rather than in conflict. We elaborate on how recognizing this relationship can have far-reaching implications for the domains of clinical practice, medical education, and health policy.
在健康哲学以及相关学科中，一个长期存在争议的问题是，明智的临床实践（“临床智慧”）在多大程度上与经验验证医学（“循证医学”——EBM）兼容，或者说可能兼容。在此，我们回应鲍姆 - 贝克尔和西斯蒂，他们不仅认为这两种知识因其来源不同而有区分，还认为循证医学有时甚至会损害明智的临床实践。我们认为，循证医学与临床智慧之间的区别定义不清晰，缺乏所采用方法的支持，且最终是错误的；我们认为，关键差异不在于某一特定临床知识的来源，而在于其可靠性。鉴于这一微妙但根本的修正，我们解释了临床智慧与循证医学必然是互补的，而非相互冲突的。我们详细阐述了认识到这种关系如何能对临床实践、医学教育和卫生政策领域产生深远影响。
