ABSTRACT
Nineteenth-century American philosopher Charles Sanders Peirce offered a picture of the scientific method that can be fruitfully applied to the practice of medical diagnosis. Physicians can use this framework to become more self-consciously aware of what they are doing when they diagnose medical conditions, and they can also learn more about the potential pitfalls of communication between physicians and their patients.
Subject(s)
Clinical Decision-Making , Diagnosis , Emotional Intelligence , Mental Processes , Physician-Patient Relations/ethics , Practice Patterns, Physicians'/ethics , Symptom Assessment , Casuistry , Clinical Competence , Clinical Decision-Making/ethics , Clinical Decision-Making/methods , Humans , Social Skills , Symptom Assessment/ethics , Symptom Assessment/methods , Symptom Assessment/psychologyABSTRACT
BACKGROUND: The term "evidence-based medicine" (or EBM) was introduced about ten years ago, and there has been considerable debate about the value of EBM. However, this debate has sometimes been obscured by a lack of conceptual clarity concerning the nature and status of EBM. DISCUSSION: First, we note that EBM proponents have obscured the current debate by defining EBM in an overly broad, indeed almost vacuous, manner; we offer a clearer account of EBM and its relation to the alternative approaches to medicine. Second, while EBM proponents commonly cite the philosophical work of Thomas Kuhn and claim that EBM is a Kuhnian 'paradigm shift,' we argue that such claims are seriously mistaken and unduly polarize the EBM debate. Third, we suggest that it is much more fruitful to understand the relationship between EBM and its alternatives in light of a different philosophical metaphor: W.V. Quine's metaphor of the web of belief. Seen in this way, we argue that EBM is an approach to medical practice that is indeed importantly different from the alternatives. SUMMARY: We can have a more productive debate about the value of EBM by being clearer about the nature of EBM and its relationship to alternative approaches to medicine.
