The necessity for clinical reasoning in the era of evidence-based medicine.

Abstract:

:Clinical decisions are increasingly driven by evidence-based recommendations of guideline groups, which aim to be based on the highest quality knowledge-randomized clinical trials (RCTs) and meta-analyses. Although RCTs provide the best assessment of the overall value of a therapy, high-quality evidence from RCTs is often incomplete, contradictory, or absent even in areas that have been most exhaustively studied. Moreover, the likelihood of the success or failure of a therapy is not identical in all the individuals treated in any trial because therapy is not the only determinant of outcome. Therefore, the overall results of a trial cannot be assumed to apply to any particular individual, not even someone who corresponds to all the entry criteria for the trial. In addition, the potential for bias due to financial conflicts remains in many guideline groups. Guidelines are key sources of knowledge. Nevertheless, limitations in the extent, quality, generalizability, and transferability of evidence mean that we clinicians must still reason through the best choices for an individual because even in the absence of full and secure knowledge, clinical decisions must still be made. Clinical reasoning is the pragmatic, tried-and-true process of expert clinical problem solving that does value mechanistic reasoning and clinical experience as well as RCTs and observational studies. Clinicians must continue to value clinical reasoning if our aim is the best clinical care for all the individuals we treat.

journal_name

Mayo Clin Proc

journal_title

Mayo Clinic proceedings

authors

Sniderman AD,LaChapelle KJ,Rachon NA,Furberg CD

doi

10.1016/j.mayocp.2013.07.012

subject

Has Abstract

pub_date

2013-10-01 00:00:00

pages

1108-14

issue

10

eissn

0025-6196

issn

1942-5546

pii

S0025-6196(13)00612-5

journal_volume

88

pub_type

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