The art and science of clinical knowledge: evidence beyond measures and numbers

@article{Malterud2001TheAA,
  title={The art and science of clinical knowledge: evidence beyond measures and numbers},
  author={Kirsti Malterud},
  journal={The Lancet},
  year={2001},
  volume={358},
  pages={397-400}
}
Medical doctors claim that their discipline is founded on scientific knowledge. Yet, although the ideas of evidence based medicine are widely accepted, clinical decisions and methods of patient care are based on much more than just the results of controlled experiments. Clinical knowledge consists of interpretive action and interaction-factors that involve communication, opinions, and experiences. The traditional quantitative research methods represent a confined access to clinical knowing… 

Topics from this paper

Reflexivity and metapositions: strategies for appraisal of clinical evidence.
  • K. Malterud
  • Medicine
    Journal of evaluation in clinical practice
  • 2002
TLDR
In this article, clinical reasoning is depicted as multilayered processes of evidence construction by means of social interaction and human interpretation, where certain rhetorical spaces rule in evidence-based practice.
Panel 1 : Terms used in qualitative
A broad base of medical and scientific knowledge is needed if medicine is to maintain its identity as a discipline founded on scientific knowledge. However, interpretive action must also be included
Recognizing Racit Knowledge in Medical Epistemology
TLDR
Michael Polanyi’s epistemology shows the need for this work and provides the structural core for building an adequate and robust medicalEpistemology that moves beyond evidence-based medicine.
The social construction of clinical knowledge - the context of culture and discourse. Commentary on Tonelli (2006), Integrating evidence into clinical practice: an alternative to evidence-based approaches. Journal of Evaluation in Clinical Practice 12, 248-256.
  • K. Malterud
  • Medicine
    Journal of evaluation in clinical practice
  • 2006
TLDR
The epistemological complexity of understanding and decision making first and foremosts demonstrates the inadequacy of a confined biomedical approach, where only questions and phenomena that can be controlled, measured and counted are regarded as valid.
Balancing health care evidence and art to meet clinical needs: policymakers' perspectives
TLDR
The views of executive-level policymakers from the Veterans Health Administration, a leader in the EBP movement, are explored regarding what constitutes evidence and the relative importance of evidence versus practical needs when determining clinical policy.
Innovating Medical Knowledge: Understanding Evidence-Based Medicine as a Socio-Medical Phenomenon
TLDR
This chapter presents the evidence-based approach as a socio-medical phenomenon and seeks to explain and negotiate the points of disagreement between supporters and detractors.
Clinical allergy has much to gain from engagement with qualitative research
TLDR
Qualitative research has enormous potential to make a distinctive contribution to knowledge about allergy management and to provide insights that quantitative studies cannot.
Challenging the epistemological foundations of EBM: what kind of knowledge does clinical practice require?
TLDR
It is argued that EBM should retain its reliabilist bent, but should look beyond formal research methodologies in identifying processes that yield reliable evidence for clinical practice, and suggests looking to feminist epistemology, with its focus on the standpoints of individual situated knowers, and the role of social context in determining what counts as knowledge.
Qualitative research series
TLDR
This work investigates the nature of clinical knowledge in medicine, exposed some of the shortcomings of quantitative research methods, and briefly introduced qualitative methods as an approach for improved understanding, and presents some overall standards.
Diagnostic knowing in general practice: interpretative action and reflexivity
TLDR
It is argued that an interpretative understanding of diagnosis can change clinical practice, complementing hypothetico-deductive strategies by recognising additional substantial diagnostic modes and giving access to scholarly reflection.
...
1
2
3
4
5
...

References

SHOWING 1-10 OF 72 REFERENCES
The legitimacy of clinical knowledge: Towards a medical epistemology embracing the art of medicine
  • K. Malterud
  • Psychology, Medicine
    Theoretical medicine
  • 1995
TLDR
A metaposition allows for inquiry of clinical knowledge, inviting an expansion of the traditional medical epistemology, provided that relevant criteria for scientific knowledge within this field are developed and applied.
Qualitative research series
TLDR
This work investigates the nature of clinical knowledge in medicine, exposed some of the shortcomings of quantitative research methods, and briefly introduced qualitative methods as an approach for improved understanding, and presents some overall standards.
Users' guides to the medical literature: XXIII. Qualitative research in health care A. Are the results of the study valid? Evidence-Based Medicine Working Group.
Quantitative research is designed to test well-specified hypotheses, determine whether an intervention did more harm than good, and find out how much a risk factor predisposes persons to disease.
Users' guides to the medical literature: XXIII. Qualitative research in health care B. What are the results and how do they help me care for my patients? Evidence-Based Medicine Working Group.
The second part of this 2-part series on how to interpret qualitative research addresses, "what are the results," and, "how do they help me care for my patients?" Qualitative analysis is a process of
Clinical interpretation: The hermeneutics of medicine
  • D. Leder
  • Psychology, Medicine
    Theoretical medicine
  • 1990
I argue that clinical medicine can best be understood not as a purified science but as a hermeneutical enterprise: that is, as involved with the interpretation of texts. The literary critic reading a
Shared understanding of the qualitative research process. Guidelines for the medical researcher.
TLDR
The qualitative research process is presented and discussed as a model, emphasizing matters frequently experienced as unfamiliar by the medical researcher, implying underlying values on construction of scientific knowledge where shared understanding--intersubjectivity--is considered as essential.
Medicine as a form of practical understanding
TLDR
Taking clinical interaction as the distinctive feature of medicine, the resemblances of medicine with the characteristics of practical reasoning in the Aristotelian sense are further explored and may be more appropriate while trying to ascribe rationality to medicine than the modern concept of rationality.
Qualitative Research: Rigour and qualitative research
TLDR
This paper gives examples of the principal approaches within qualitative research and summarises them into a methodological checklist to help readers of reports of qualitative projects to assess the quality of the research.
Scientific rigour in qualitative research--examples from a study of women's health in family practice.
TLDR
Alternative criteria for scientific rigour, initially introduced by Lincoln and Guba, are presented: credibility, dependability, confirmability and transferability, which have been applied to a research project with in-depth interviews with female patients suffering from chronic pain in the locomotor system.
The (Gendered) Construction of Diagnosis Interpretation of Medical Signs in Women Patients
  • K. Malterud
  • Psychology, Medicine
    Theoretical medicine and bioethics
  • 1999
TLDR
The theoretical analysis is supported by semiotic perspectives of bodily signs, feminist theory on experience, and Foucault's ideas about medical perception and gaze, and concludes that a medical diagnosis is seldom a biological fact, but the outcome of a process where biological, cultural and social elements are interwoven.
...
1
2
3
4
5
...