Chin-Yee Benjamin, Upshur Ross
Department of Medicine, University of Toronto, Toronto, Canada.
Department of Family and Community Medicine and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
J Eval Clin Pract. 2018 Jun;24(3):638-645. doi: 10.1111/jep.12852. Epub 2017 Dec 13.
Clinical judgement is a central and longstanding issue in the philosophy of medicine which has generated significant interest over the past few decades. In this article, we explore different approaches to clinical judgement articulated in the literature, focusing in particular on data-driven, mathematical approaches which we contrast with narrative, virtue-based approaches to clinical reasoning. We discuss the tension between these different clinical epistemologies and further explore the implications of big data and machine learning for a philosophy of clinical judgement. We argue for a pluralistic, integrative approach, and demonstrate how narrative, virtue-based clinical reasoning will remain indispensable in an era of big data and predictive analytics.
临床判断是医学哲学中的一个核心且长期存在的问题，在过去几十年中引发了广泛关注。在本文中，我们探讨了文献中阐述的临床判断的不同方法，特别关注数据驱动的数学方法，并将其与基于叙事、美德的临床推理方法进行对比。我们讨论了这些不同临床认识论之间的紧张关系，并进一步探讨了大数据和机器学习对临床判断哲学的影响。我们主张采用多元、综合的方法，并展示基于叙事、美德的临床推理在大数据和预测分析时代如何仍然不可或缺。
