A Review of the Evidence-Based Medicine Realm Based on Two Factors: The Nature of Science and Decision Making Situation

Review of the literature shows that clinical decision-making is not often based on scientific evidence and in many cases it results from personal experience، subjectivity، and previous models or methods used in clinical wards. In other words، we cannot say with confidence whether the diagnostic decisions are the best possible decisions in clinical settings and most beneficial for the patient? Is it possible to make all decisions based on strong scientific evidence? As the element of «decision» constitutes the core of medical education، this paper aims to review the status of evidence-based medicine in terms of nature of science and circumstances of decision making in order to extend the concept of evidence-based medicine. This research was qualitative، using an analytical-theoretical method through the integration of the decision making theories and nature of science based on these criteria: certainty of situation، predictability، certainty of theories، objectivity، thinking، and openness. Based on the existing theoretical methods of decision making in the range of certainty to uncertainty، decision-making was classified into three categories. Also based on the mentioned indicators، science was classified into basic sciences (non-living systems)، experimental sciences (living systems) and humanities (social sciences). Finally، based on the analytical approach، the conceptual framework was drawn. As the nature of medical sciences is experimental، the development of evidence-based medicine approach can foster the critical evaluation of scientific evidence، reduce subjective judgment، and lead to the gradual formation of new ideas.