Clinical Expertise and Evidence-based Medicine in Practice

Stéphanie Van Droogenbroeck, Ives Hubloue

Onderzoeksoutput: Meeting abstract (Book)



Evidence-based medicine (EBM) is seen as the golden standard for diagnostic and therapeutic measures in clinical practice. The standard definition of EBM states that it is an integration of the best research evidence with clinical expertise and patient values. (Sackett 2000) Some critics (e.g. Braude 2009 and Henry 2006) on EBM mention that it neglects clinical expertise, but the definition on EBM does embrace expertise. However the question remains how this expertise and EBM are used in clinical practice. More specifically, what role does expertise and research evidence play in acute and critical care at an emergency department?


An ethnographic study in two Belgian urban hospitals has been conducted. Patients with internal medical complaints at the emergency departments, two wards and five departments at the outpatient clinic were included. The entire medical setting was observed, semi-structured interviews were taken from patients and their family. These data are analyzed with the grounded theory approach.

Results and Discussion

In acute and critical care situations healthcare professionals are highly time constrained. The use of research evidence is minimized to the mere use of guidelines. Most decisions are almost exclusively based on clinical expertise. Physicians "look for a story that fits". This strategy implies that physicians apply a method of pattern recognition and want to reach a situation where everything falls into place like a puzzle such that "it feels right". In short, expertise should get a more prominent role in the definition of EBM.

Braude H. Clinical Intuitions versus Statistics: different modes of tacit knowledge in clinical epidemiology and evidence-based medicine, Theoretical Medicine and Bioethics, 30, 2009: 181-198.
Henry, S.G. Recognizing tacit knowledge in medical epistemology, Theoretical Medicine and Bioethics, 27, 2006: 187-213.
Sackett DL. Evidence-based Medicine: How to Practice and Teach EBM, 2nd edn. Edinburgh: Churchill Livingstone, 2000.
Originele taal-2English
TitelFourth Young Researchers Days in Logic, Philosophy of Science and History of Science
StatusPublished - 2014

Publicatie series

Naamorganized in partnership with the 3èmes Rencontres doctorales internationales en Philosophie des Sciences, Louvain la Neuve


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