• dreams;
  • evidence-based medicine;
  • irrational;
  • knowledge;
  • memory;
  • reduction;
  • tact;
  • squint;
  • world


Following my own involvement in the rise of evidence-based medicine in General Practice in the UK, and having seen how this tide has led to a relative devaluation of other kinds of knowing this paper sets out four alternative approaches to the problem of knowledge in a way which both undermines the predominance of a strictly evidence-based approach and re-emphasizes these other means through which we come to know the world. Philosophically, this brings together the works of Heidegger, Sebald, Bachelard and Gadamer and shows how these apparently disparate authors suggest that there is, underlying our empirical understanding of the world, a more primordial relationship between consciousness and world which supports empirical or evidence-based knowledge and without which evidence-based knowledge cannot be applied in practice. The implications for clinical practice of this kind of thinking should be a more cautious approach to the use of evidence and a greater emphasis and reliance on the discretion and judgement of clinical professionals.