ABSTRACT
This chapter examines how the shift from a clinical judgment model of knowledge in medicine to an evidence-based model affects the delivery of care to patients. The two accounts of knowledge are quite different: the clinical judgment model teaches and privileges a picture of knowledge that emphasizes the skill and expertise of the individual clinician, while the evidence-based model focuses on the resources created by large-scale clinical studies. Both models have strengths. A good clinician will have diagnostic skills that go far beyond what an evidence-based decision-making tree can offer, while the evidence-based model can help caregivers move beyond outdated and ineffective treatment modalities. From an ethics of care perspective, there are many benefits to the shift to an evidence-based model, including a greater capacity to incorporate the knowledge base of practitioners who are not physicians (what I term a democratization of medical knowledge) but there are also significant drawbacks including a loss of expertise, over-standardized care, and a bias toward certain types of treatments. Recognizing the weaknesses of the evidence-based model is crucial for addressing how best to provide skilled care to patients.
