Within the evidence-based medicine (EBM) construct, clinical expertise is acknowledged to be both derived from primary experience and necessary for optimal medical practice. Primary experience in medical practice, however, remains undervalued. Clinicians’ primary experience tends to be dismissed by EBM as unsystematic or anecdotal, a source of bias rather than knowledge, never serving as the “best” evidence to support a clinical decision. The position that clinical expertise is necessary but that primary experience is untrustworthy in clinical decision-making is epistemically incoherent. Here we argue for the value and utility of knowledge gained from primary experience for the practice of medicine. Primary experience provides knowledge necessary to diagnose, treat, and assess response in individual patients. Hierarchies of evidence, when advanced as guides for clinical decisions, mistake the relationship between propositional and experiential knowledge. We argue that primary experience represents a kind of medical knowledge distinct from the propositional knowledge produced by clinical research, both of which are crucial to determining the best diagnosis and course of action for particular patients.

在循证医学 (EBM) 结构中，公认的临床专业知识既来自初级经验，又是最佳医疗实践所必需的。然而，医疗实践的主要经验仍然被低估。临床医生的主要经验往往被 EBM 视为不系统或轶事，是偏见而不是知识的来源，从来没有作为支持临床决策的“最佳”证据。临床专业知识是必要的，但在临床决策中主要经验不可信的立场在认识上是不连贯的。在这里，我们论证了从医学实践的主要经验中获得的知识的价值和效用。初级经验提供了诊断、治疗和评估个体患者反应所需的知识。证据的层次，当作为临床决策指南提出时，错误地理解命题知识和经验知识之间的关系。我们认为，初级经验代表了一种不同于临床研究产生的命题知识的医学知识，这两者对于确定特定患者的最佳诊断和行动方案至关重要。