Critique of influential epistemological presuppositions in clinical reasoning.

Evidence-based medicine is an important resource in modern clinical reasoning. It is, however, widely discussed how judgement, experience and patient perspectives are supposed to be integrated in evidence-based decision-making. They are recognised as important aspects, but their epistemological status has remained unclarified. In this article, it is argued that we need to consider three different yet related epistemological problems in order to obtain a better understanding of these aspects in clinical reasoning. Even though judgement and values are mentioned in the decision-making procedure, better clinical reasoning is typically linked to detachment, neutrality and monological conceptions of rationality. In this article, it is argued that rational clinical decision-making must also include position-dependent experiences, values and dialogical deliberation.