Reasoning, evidence, and clinical decision‐making: The great debate moves forward

Abstract

When the editorial to the first philosophy thematic edition of this journal was published in 2010, critical questioning of underlying assumptions, regarding such crucial issues as clinical decision making, practical reasoning, and the nature of evidence in health care, was still derided by some prominent contributors to the literature on medical practice. Things have changed dramatically. Far from being derided or dismissed as a distraction from practical concerns, the discussion of such fundamental questions, and their implications for matters of practical import, is currently the preoccupation of some of the most influential and insightful contributors to the on-going evidence-based medicine debate. Discussions focus on practical wisdom, evidence, and value and the relationship between rationality and context. In the debate about clinical practice, we are going to have to be more explicit and rigorous in future in developing and defending our views about what is valuable in human life.

What is “shared” in shared decision‐making? Philosophical perspectives, epistemic justice, and implications for health professions education

“…It is with these reflections on and interrogations of how SDM could take place within an era of evidence-based medicine EBM emerged in the 1990s from the field of clinical epidemiology 16 and has since received abundant attention in the literature. 17 Since the introduction of EBM, critics have argued for more inclusive notions of evidence and the integration of various forms of knowledge derived from different ontologies and epistemologies. 6,[18][19][20][21] Discussions have focussed on when and under what circumstances various forms of knowledge can be justifiably evoked and ultimately mobilized for clinical decision-making.…”

“…EBM emerged in the 1990s from the field of clinical epidemiology and has since received abundant attention in the literature . Since the introduction of EBM, critics have argued for more inclusive notions of evidence and the integration of various forms of knowledge derived from different ontologies and epistemologies .…”

Interpreting research to inform practice: The hierarchy of evidence framework

“…The "Mother discourse" is the planning and structuring part of the research process; the health care professional's own draftwriting, ideas and formation of critical questions. This approach allows for evidence that is underpinned by "patterns of knowing" (Carper, 1978) not recognised by the familiar HoE hierarchies on which one bases clinical judgement to formulate new questions (Loughlin, Bluhm, Buetow, Borgerson & Fuller, 2017). The "Father discourse," is the most valid and evidence-based supporting action; the supplementary research that is empirical and canonical, to which we attach our argument.…”

“…More importantly, referring to the Familial model, students could map their textual understanding of the HoE framework. In all the statements received by the students there was a sense that as health professionals they were defining their own criterion for evidence and therefore being proactive in decision making (Loughlin et al, 2017).…”

The Importance of Physician Climate Advocacy in the Face of Political Denial

“…It might also be useful to compare the functions of skepticism in medical practice with skepticism regarding climate science. Imbued with their everyday need to consider nuanced human bodily, social, and moral complexities when treating individual patients, some clinicians and medical educators maintain a spirit of doubt and uncertainty in clinical reasoning and evidence [43][44][45][46]. They might then transfer their habitual skepticism to climate science.…”