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…
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References
SHOWING 1-10 OF 72 REFERENCES
The legitimacy of clinical knowledge: Towards a medical epistemology embracing the art of medicine
- Psychology, MedicineTheoretical medicine
- 1995
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
- Medicine
- 2001
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.
- MedicineJAMA
- 2000
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.
- MedicineJAMA
- 2000
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
- Psychology, MedicineTheoretical 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.
- MedicineFamily practice
- 1993
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
- Psychology, MedicineTheoretical medicine
- 1987
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
- Computer Science, MedicineBMJ
- 1995
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.
- MedicineFamily practice
- 1994
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
- Psychology, MedicineTheoretical medicine and bioethics
- 1999
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.