Facts, ideas and evidence in medicine.

What is it about?

When evidence‐based medicine (EBM) became established, its dominant rhetoric was about matters of fact and about developing better ways to bring scientific fact into medical practice. A huge amount of effort has gone into refining the ways that trials are conducted, reported and then the results synthesised to produce a platform for evidence based clinical decision making. However, decision making in real life always requires more than matters of fact. It requires judgements based on experience, on previous knowledge and a consideration of whether what can be learned from a scientific investigation conducted in one place can be applied somewhere else. Thinking which focusses only on matters of fact is called empiricism. Thinking which is used to make complex judgements is called rationalism. This paper suggest that the practice of evidence based medicine has been dominated by empiricist thinking and that it is now time to concentrate on the rationalist side of the equation.

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Why is it important?

If we only focus on a narrow definition of evidence the potential of evidence-based medicine will be sub-optimal

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