Clinical expertise has since 1891 a Swedish counterpart in proven experience. This study aims to increase our understanding of clinicians' views of their professional expertise, both as a source or ...body of knowledge and as a skill or quality. We examine how Swedish healthcare personnel view their expertise as captured by the (legally and culturally relevant) Swedish concept of "proven experience," through a survey administered to a simple random sample of Swedish physicians and nurses (2018, n = 560). This study is the first empirical attempt to analyse the notion of proven experience as it is understood by Swedish physicians and nurses. Using statistical techniques for data dimensionality reduction (confirmatory factor analysis and multidimensional scaling), the study provides evidence that the proven experience concept is multidimensional and that a model consisting of three dimensions-for brevity referred to as "test/evidence", "practice", and "being an experienced/competent person"-describes the survey responses well. In addition, our results cannot corroborate the widely held assumption in evidence-based medicine that an important component of clinical expertise consists of experience of patients' preferences.
This article analyses the role of scientific information in legal proceedings by exploring the relationship of law, science and the factual world. The article compares legal and scientific ontology, ...and discusses how they relate to each other. The comparison is used to explain previous controversies between legal and scientific experts. Special consideration is devoted to the legal notion of cause-in-fact, which is discussed at length. The article distinguishes among different meanings of “facticity” in the legal discourse on causation, and discusses the bearing that these meanings have on the legal relevance of scientific information.
High-quality healthcare decisions need to balance input from science and clinical practice. When two sources of evidence — such as scientific and practice-derived evidence — are compared, integrated, ...or need to stand-in for one another, they need to be comparable on similar dimensions. Since 1891, Swedish physicians have been operating under a legal requirement to base their healthcare decisions on science and “proven experience” (approximately clinical expertise), and today all healthcare personnel in Sweden fall under this legal requirement.
We investigated the dynamics between these two kinds of evidence with respect to importance, systematicity, and certainty by studying Swedish healthcare professionals.
Survey to professionals; document studies of political discourse.
In this study, a survey was sent to simple random samples of Swedish professionals in medicine, nursing, occupational therapy, dentistry, and dental hygiene, asking about the roles of science and proven experience in medical decision making. Outcome measures were how important, certain, and systematic science and proven experience are for successful medical decision making.
The sampling frame was each profession's most recent occupational registry accessed by the Swedish federal statistical agency. 3500 surveys were distributed. 1626 surveys were returned. 26 participants were removed prior to analysis (exclusion criteria: more than one profession indicated, missing certificate, and mistake in stratum). The final sample consisted of 295 physicians, 300 nurses, 365 occupational therapists, 339 dentists, and 301 hygienists. 162 responses in questions used as variables in the analyses were either uninterpretable or empty; those were replaced with the modal response for a given participant's profession on a given question.
In the study, proven experience's perceived importance for clinical decision making is positively correlated with its certainty and systematicity, and an increased certainty and systematicity is positively correlated with a diminished difference in importance between science and proven experience for almost all professions surveyed in this study.
Proven experience has an evidentiary role in clinical decision making, and this role depends in part on its certainty and systematicity. Notably, this makes the EBM-based perspective that practice-derived knowledge is primarily of implementation value less plausible.
This article examines the relevance of scientific expertise and evidence in political decision making. It takes as its starting point the criticism levelled at the Swedish government for allowing ...scientific expertise and the lack of evidence to stand in the way of resolute political interventions to combat the coronavirus. The article identifies and distinguishes between different kinds of argument put forward to explain why the Swedish approach was a mistake. While accepting the arguments as such, the article claims that these arguments have been used in a way that erroneously assumes that the only rationale for requiring political measures to be evidence-based is to guarantee the effectiveness of the measures as such. The article points out other roles that evidence can play in political decision-making and shows that the same considerations that can justify the arguments, can also be used to warrant a demand for even more scientific expertise and evidence.
This paper compares two seemingly very different models for evidence management and decision making: the model of evidence based medicine, EBM, and the model of free evaluation of evidence (as ...applied in the Swedish judiciary system). Whereas EBM identifies and ranks the relevant kinds of evidence that a decision-maker should consider, the model of free evaluation of evidence relies on the idea that truth is best pursued freely, and that the decision maker's evaluation of evidence should not be governed by rules. The paper compares the levels of freedom in the two models with respect to what evidence to consider, how to assess the value of different pieces of evidence, and how to estimate the combined value of all the evidence. It concludes that the two models diverge in other ways than first assumed, and that the juxtaposition of them can be beneficial to both models, by casting light on underlying but seemingly unwarranted assumptions relating to the role of intuition and life experience in the evaluation of evidence.
The standard of proof in criminal trials should require that the evidence presented by the prosecution is robust. This requirement of robustness says that it must be unlikely that additional ...information would change the probability that the defendant is guilty. Robustness is difficult for a judge to estimate, as it requires the judge to assess the possible effect of information that the he or she does not have. This article is concerned with expert witnesses and proposes a method for reviewing the robustness of expert testimony. According to the proposed method, the robustness of expert testimony is estimated with regard to competence, motivation, external strength, internal strength and relevance. The danger of trusting non-robust expert testimony is illustrated with an analysis of the Thomas Quick Case, a Swedish legal scandal where a patient at a mental institution was wrongfully convicted for eight murders.
This article analyses the role of scientific information in legal proceedings by exploring the relationship of law, science and the factual world. The article compares legal and scientific ontology, ...and discusses how they relate to each other. The comparison is used to explain previous controversies between legal and scientific experts. Special consideration is devoted to the legal notion of cause-in-fact, which is discussed at length. The article distinguishes among different meanings of “facticity” in the legal discourse on causation, and discusses the bearing that these meanings have on the legal relevance of scientific information.
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