Dr. Bluhm is a philosopher of science who recently co-authored a book with pulmonary and critical care doctor Dr. Tonelli called “On What Evidence? Making The Case For Medical Decision-Making” where they explicate an alternative model of how to think about justifying medical decision making with evidence.
In their model, the conceive of medical decision making as making a case for a particular course of action in a particular patient case. At the physician’s disposal they have many kinds of justification at their disposal: 1) Population level data 2) Pathophysiological Rationale 3) Clinical experience & 4) Patient Values. The proper weighting of these sources of justification depend on the context. Dr. Bluhm—a philosopher of science—explores the nuances of this model broadly in the philosophical literature in today’s episode. To hear a more clinically oriented podcast about similar topics, consider listening to my episode with Dr. Tonelli .
Show Notes
[0:00] How philosophy of medicine is more than just ethics
[2:00] The case for the “case based reasoning model” of evidence based medicine
[5:00] Experiential Knowledge and it’s value in clinical reasoning
https://journals.lww.com/ajnonline/citation/1984/12000/from_novice_to_expert_excellence_and_power_in.25.aspx
Sarah Wieten’s article on“Expertise in evidence-based medicine: a tale of three models.” https://link.springer.com/article/10.1186/s13010-018-0055-2
[14:00] What transforms clinical experience into experiential knowledge?
Shapiro D 2012. “‘Objectivity’ and the arbitration of experiential knowledge.” Social Philosophy Today 28(January): 67–82.
[20:00] How do appeals to guidelines avoid just being naive appeals to authority?
[26:00] How might students think about the tension between guidelines and their growing clinical experience?
[29:00] How Bluhm and Tonelli attempt to make sense of disputes between physicians when both parties base their reasoning on clinical experience
[32:00] How expertise in general is being challenged and how that might inform future conversations about justified medical decision-making
[35:00] The importance of withholding judgement about the reliability of mechanistic knowledge (which can be full of gaps!)
