Recognizing racit knowledge in medical epistemology

Research output: Contribution to journalArticle

72 Scopus citations

Abstract

The evidence-based medicine movement advocates basing all medical decisions on certain types of quantitative research data and has stimulated protracted controversy and debate since its inception. Evidence-based medicine presupposes an inaccurate and deficient view of medical knowledge. Michael Polanyi's theory of tacit knowledge both explains this deficiency and suggests remedies for it. Polanyi shows how all explicit human knowledge depends on a wealth of tacit knowledge which accrues from experience and is essential for problem solving. Edmund Pellegrino's classic treatment of clinical judgment is examined, and a Polanyian critique of this position demonstrates that tacit knowledge is necessary for understanding how clinical judgment and medical decisions involve persons. An adequate medical epistemology requires much more qualitative research relevant to the clinical encounter and medical decision making than is currently being done. This research is necessary for preventing an uncritical application of evidence-based medicine by health care managers that erodes good clinical practice. Polanyi's epistemology shows the need for this work and provides the structural core for building an adequate and robust medical epistemology that moves beyond evidence-based medicine.

Original languageEnglish (US)
Pages (from-to)187-213
Number of pages27
JournalTheoretical Medicine and Bioethics
Volume27
Issue number3
DOIs
StatePublished - Jun 2006
Externally publishedYes

Keywords

  • Clinical judgment
  • Edmund Pellegrino
  • Evidence-based medicine
  • Medical epistemology
  • Michael Polanyi
  • Tacit knowledge

ASJC Scopus subject areas

  • Social Sciences (miscellaneous)
  • Public Health, Environmental and Occupational Health

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