One definition of Evidence Based Medicine is
the conscientious, explicit, and judicious use of current best
evidence in making decisions about the care of individual patients. The
practice of evidence based medicine means integrating individual clinical
expertise with the best available external clinical evidence from
systematic research.
Sackett
et al 1996.
In the same article, the authors point out that
Good doctors use both individual clinical expertise and the best
available external evidence, and neither alone is enough. Without clinical
expertise, practice risks becoming tyrannised by evidence, for even
excellent external evidence may be inapplicable to or inappropriate for an
individual patient. Without current best evidence, practice risks becoming
rapidly out of date, to the detriment of patients.
A recently published book by Malcolm Gladwell highlights the value of
individual expertise, which you might also call clinical judgment or simply
intuition.
The author describes his book
It's a book about rapid cognition, about the kind of thinking that
happens in a blink of an eye. When you meet someone for the first time, or
walk into a house you are thinking of buying, or read the first few
sentences of a book, your mind takes about two seconds to jump to a series
of conclusions. Well, "Blink" is a book about those two seconds, because I
think those instant conclusions that we reach are really powerful and
really important and, occasionally, really good. You could also say that
it's a book about intuition, except that I don't like that word. In fact it
never appears in "Blink." Intuition strikes me as a concept we use to
describe emotional reactions, gut feelings--thoughts and impressions that
don't' seem entirely rational. But I think that what goes on in that first
two seconds is perfectly rational. It's thinking--its just thinking that
moves a little faster and operates a little more mysteriously than the kind
of deliberate, conscious decision-making that we usually associate with
"thinking." In "Blink" I'm trying to understand those two seconds. What is
going on in inside our heads when we engage in rapid cognition? When are
snap judgments good and when are they not? What kinds of things can we do
to make our powers of rapid cognition better?
www.gladwell.com/blink/index.html
I have not yet read the book, but it sounds like a good counterpoint to the
belief that a careful, thoughtful, rational analysis is always best.
Here are some of the references that suggest the opposite viewpoint, that
intuition is not as good as a careful analysis. Some of these I have read,
and others were recommended to me just recently.
I'd like to write up a few examples of how our intuition often fails us,
especially when we really on
anecdotal evidence.
I touch on this briefly in my speech,
Is the randomized trial the gold
standard for research?.
07/08/2008.
