[Evidence-based medicine as a model of decision making in clinical practice].
BACKGROUND
The way how we apply the principles of evidence-based medicine in the real clinical world is based on a number of implicitly assumed theoretical models. The aim of the present article is to identify these theories and use their impact to explain their importance for the application of evidence-based medicine.


METHODS
Philosophical theories were analysed with regard to their impact on the present investigation, i.e. their ability to explain the implicit theoretical background to this way of practising evidence-based medicine. In a second step, the theories identified were used to discuss the question of clinical decision making. The model of the hermeneutic approach to clinical casework was used to introduce a strategy for everyday application of evidence-based medicine in the clinical field.


CONCLUSIONS
In the context of these theories, there are three archetypal models of clinical decision making. These include the intuitive, the hypothesis-based and the evidence-based approach. In this sense, evidence-based medicine is a hermeneutic model for making clinical decisions. The mean impact of evidence-based medicine is the introduction of the best external evidence as a basis of the hermeneutic clinical casework. In the model of the "best external evidence", the clinician experiences a great change in clinical decision making. This change is generated by crossing the border from applying scientific clinical hypotheses to systematically identified and reviewed results of high-quality research work. In this sense, hermeneutic casework demonstrates that there is a contradictory unity between evidence-based clinical data and the clinician's understanding of a clinical case--a contradiction that may only be solved by the clinician's internal evidence.
Siebolds
Marcus
M
Katholische Fachhochschule Nordrhein Westfalen, Abt. Köln, Fachbereich Gesundheitswesen. M.Siebolds@KFHNW.de
D004501:Education, Medical; D019317:Evidence-Based Medicine; D006801:Humans; D008962:Models, Theoretical