Tacit knowledge as the unifying factor in evidence based medicine and clinical judgement

Tim Thornton

doi:10.1186/1747-5341-1-2

Abstract

The paper outlines the role that tacit knowledge plays in what might seem to be an area of knowledge that can be made fully explicit or codified and which forms a central element of Evidence Based Medicine. Appeal to the role the role of tacit knowledge in science provides a way to unify the tripartite definition of Evidence Based Medicine given by Sackett et al: the integration of best research evidence with clinical expertise and patient values. Each of these three elements, crucially including research evidence, rests on an ineliminable and irreducible notion of uncodified good judgement.The paper focuses on research evidence, drawing first on the work of Kuhn to suggest that tacit knowledge contributes, as a matter of fact, to puzzle solving within what he calls normal science. A stronger argument that it must play a role in research is first motivated by looking to Collins' first hand account of replication in applied physics and then broader considerations of replication in justifying knowledge claims in scientific research. Finally, consideration of an argument from Wittgenstein shows that whatever explicit guidelines can be drawn up to guide judgement the specification of what counts as correctly following them has to remain implicit.Overall, the paper sets out arguments for the claim that even though explicit guidelines and codifications can play a practical role in informing clinical practice, they rest on a body of tacit or implicit skill that is in principle ineliminable. It forms the bedrock of good judgement and unites the integration of research, expertise and values.

Highlights

In their book, Evidence-based Medicine: How to practice and teach EBM, David Sackett, Sharon Straus, Scott Richardson, William Rosenberg, and Brian Haynes define it as follows
'Evidence based medicine is the integration of best research evidence with clinical expertise and patient values.' [1]
Arguments drawn from Collins' analysis of empirical replication and the argument from Wittgenstein's consideration of rule governed judgement show that such tacit knowledge is in principle ineliminable

Summary

Introduction

Evidence-based Medicine: How to practice and teach EBM, David Sackett, Sharon Straus, Scott Richardson, William Rosenberg, and Brian Haynes define it as follows. I will outline a principled reason for this approach by outlining a role for tacit knowledge in scientific practice including its role in research This will undermine the view of evidence-based judgement as algorithmic and help undermine the comparison that that idea motivates. The examples drawn from cookery and from applied physics suggest a key role for tacit knowledge It is not, merely the kind of practical know-how involved in dexterous manipulation of the environment. Arguments drawn from Collins' analysis of empirical replication and the argument from Wittgenstein's consideration of rule governed judgement show that such tacit knowledge is in principle ineliminable This is not to say, that codifications can play no useful practical roles.

Draw conclusions: publish results

Conclusion

McDowell J