Abstract

The view that experts have special access to knowledge goes back at least as far as Plato. In medicine this view has been particularly influential: experienced clinicians are often believed to possess tacit knowledge and intuition that cannot be reduced to mechanical rules. The deference to clinical judgment is reflected in the ways doctors are trained. After spending 2 or 3 years studying the basic sciences, medical students spend the next 2–3 years doing ‘clinical’ work, where they are essentially apprentices to more senior (expert) colleagues in the hospital. In stark contrast with the more traditional view, EBM proponents advocate the epistemic superiority of comparative clinical research, preferably from randomized trials. In this paper, I will contend that the EBM position on expert judgment as evidence is well supported by a plethora of largely ignored studies, but that other roles for expert judgment are equally important and deserve more discussion in the EBM literature.