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Hi Peter, From a quick read, it seems the same old in the sense that by reducing ebm to quantitative data they can weight an argument about lack of balance im not sure that most involved in ebm would limit it to quantifiable data and ignore experience and preference. However, Iıd suggest that in terms of the international literature, the areas of clinical experience and patient preference often get lost and more work needs to be done probably working with critics of EBHC to highlight that evidence is a ³part² of the picture. Its time to give attention to these other dimensions and draw out what they mean, how they can be applied etc. regards Craig Lockwood Associate Director Research and Innovation The Joanna Briggs Institute Royal Adelaide Hospital North Terrace Adelaide, South Australia 5000 p: +61 8 8303 4880 f: +61 8 8303 8280 Submit your paper for the 2007 JBI International Convention before 1 July 2007 http://www.joannabriggs.edu.au/events/2007Convention From: Peter Renshaw <[log in to unmask]> Reply-To: Peter Renshaw <[log in to unmask]> Date: Fri, 23 Mar 2007 09:33:42 +1100 To: "[log in to unmask]" <[log in to unmask]> Subject: Re: March Academic medicine Yet another paper that assumes that evidence-based practice is all about statistics and completely ignores that the well-described role of clinical experience in the application of evidence-based medicine (not to mention patient preferences). Have we failed to highlight clinical experience enough? Peter Renshaw Tasmania The following may be of interest Viewpoint: Moving Beyond Evidence-Based Medicine [Evidence-Based Medicine] Henry, Stephen G. MD; Zaner, Richard M. PhD; Dittus, Robert S. MD, MPH Dr. Henry is an intern, University of Michigan Health System, Department of Internal Medicine, Ann Arbor, Michigan. Dr. Zaner is Ann Geddes Stahlman Professor Emeritus of Medical Ethics and Philosophy of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. Dr. Dittus is Albert and Bernard Werthan Professor of Medicine; chief, Division of General Internal Medicine and Public Health; director, Institute for Medicine and Public Health; Vanderbilt University Medical Center; and director, Geriatric Research, Education and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, Tennessee. Correspondence should be addressed to Dr. Henry, Internal Medicine Residency Program, 3116 G Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0368; telephone: (734) 545-0989; fax: (734) 936-3654; e-mail: ([log in to unmask]). Abstract\l "toc" \l "toc" The evidence-based medicine movement has remained both well known and controversial since its inception. The authors reframe the evidence-based medicine debate by pointing out an underappreciated epistemological deficiency: evidence-based medicine as currently conceptualized cannot accommodate concepts that resist quantitative analysis and therefore cannot logically differentiate human beings from complex machines. The authors use Michael Polanyi's philosophy of tacit knowing (which refers to the taken-for-granted knowledge at the periphery of attention that allows persons to understand the world and discern meaning in it) as a starting point for rectifying this deficiency and for working towards an improved, person-centered epistemology of medical practice. The authors demonstrate that not only evidence-based medicine but also most traditional theories of medical practice need a concept such as tacit knowing to account for the kinds of knowledge human beings actually use. Polanyi's philosophy of tacit knowing is defined and briefly explained. A medical epistemology that can account for the tacit dimension of human knowledge and recognize physicians and patients as persons requires a revised conception of medical uncertainty and a recognition that clinicianpatient interactions are central to medicine. The authors discuss practical implications of tacit knowing for medical practice, education, research, and health care policy and suggest ways for moving beyond evidence-based medicine towards a comprehensive epistemology of medical practice.