ABSTRACT
Clinical judgment does not generate the puzzle just described because it is propositional: the current best evidence and patient preferences justify propositions about patient care. The puzzle of evidence-based practice arises when one try to link guidelines to activities. Even if qualitative evidence made tacit knowledge explicit, people remain stuck with the problem of how to re-embed it into practice. While Gweneth Doane and Coleen Varcoe have understood the puzzle of evidence-based practice more deeply than most other authors, their positive solution fares no better than the other attempts. The solution to the puzzle of evidence-based practice requires to think differently about human agency and action. The ecological conception of agency is a complex bundle of interacting, but partially autonomous, embodied capacities with which people engage the environment. Some of these capacities are conscious, in the sense that people can report them to others; some of these capacities are not penetrable by self-reflection.
