Open Access Open Access  Restricted Access Subscription Access

Case-based reasoning

Mark Tonelli


The clinical case has been central to the practice of medicine since its inception, but the perceived value of the case, both a source of knowledge and as the basis for clinical decision making, has declined in the era of evidence-based medicine. Thinking in cases, however, is necessary for the practice of person-centered healthcare, ensuring that the individuality of the case-at-hand is recognized and incorporated into diagnostic and therapeutic decisions. The case-at-hand will be compared to other cases, derived from clinical research, pathophysiologic understanding, and clinical experience, as these kinds of cases serve as the repository of medical knowledge. Utilizing analogy and argument, clinicians derive and negotiate warrants relevant to particular patients, in order to make diagnoses, recommendations, and decisions. Case-based reasoning provides a rigorous and explicit framework for delivering person-centered care to individuals seeking healing.


Casuistry, clinical decision-making, evidence-based medicine, medical epistemology, person-centered healthcare

Full Text:



Foucalt, M. (Trans. A.M. Sheridan Smith). (1994). The Birth of the Clinic. New York: Vintage.

Tonelli, M.R. (2006). Integrating evidence into clinical practice: an alternative to evidence-based approaches. Journal of Evaluation in Clinical Practice 12 (3) 248-256.

Norman, G. (2005). Research in clinical reasoning: past history and current trends. Medical Education 39 (4) 418-427.

Norman, G. (2007). Non-analytical models of clinical reasoning: the role of experience. Medical Education 41, 1140-1145.

Ankeny, R.A. (2007). Wormy logic: Model organisms as case-based reasoning. In: Science without laws: Model systems, cases, exemplary narratives. Creager, A.N.H., Lunbeck, E. & Wise M.N. (Eds.). Durham: Duke University Press.

Schaffner, K.F. (1986). Exemplar reasoning about biological models and diseases: a relation between the philosophy of medicine and philosophy of science. Journal of Medicine and Philosophy 11 (1) 63-80.

Blois, M.S. (1988). Medicine and the nature of vertical reasoning. New England Journal of Medicine 318 (13) 847-851.

Braude, H.D. (2012). Intuition in medicine: a philosophical defense of clinical reasoning. Chicago: The University of Chicago Press.

Caponi, S. (2013). Quetelet, the average man and medical knowledge. História, Ciências, Saúde-Manguinhos 20 (3) 830-847.

Upshur, R.E.G. & Colak, E. (2003). Argumentation and evidence. Theoretical Medicine and Bioethics 24 (4) 283-299.

Toulmin, S. (2003). The Uses of Argument. Cambridge: Cambridge University Press.

Henry, S. (2006). Recognizing tacit knowledge in medical epistemology. Theoretical Medicine and Bioethics 27 (3) 187-213.

Pellegrino, E. & Thomasma, D. (1988). For the Patient's Good: The Restoration of Beneficence in Health Care. New York: Oxford University Press.

Davis, F.D. (1997). Phronesis, clinical reasoning, and Pellegrino's philosophy of medicine. Theoretical Medicine and Bioethics 18 (1-2) 173-195.

Blunt, C. (2015). Hierarchies of evidence in evidence-based medicine. PhD thesis, LSE. Available at:

Sackett, D.L., Rosenberg, W.M., Gray, J.A., Haynes, R.B. & Richardson, W.S. (1996). "Evidence based medicine: what it is and what it isn't." British Medical Journal 312 (7023) 71-72.

Jonsen, A.R. & Toulmin, S. (1988). The Abuse of Casuistry. Berkeley: University of California Press.

Fulford, K., Piele, E. & Carroll, H. (2012). Essential Values-based Practice: Clinical Stories Linking Science with People. Cambridge: Cambridge University Press.

Jonsen, A., Siegler, M. & Winslade, W. (2002). Clinical Ethics. 5th edn. New York: McGraw-Hill.

Sullivan, M.D. (2016). The Patient as Agent of Health and Health Care. Oxford: Oxford University Press.

Cassell, E.J. (2013). The Nature of Healing. Oxford: Oxford University Press.

Weiner, S.J., Alan Schwartz, A., Sharma, G., Binns-Calvey, A., Ashley, N., Kelly, B., Dayal, A., Patel, S., Weaver, F.M. & Harris, H. (2013). Patient-centered decision making and health care outcomes: An observational study. Annals of Internal Medicine 158 (8) 573-579.

Charon, R. (2006). Narrative Medicine: Honoring the Stories of Illness. Oxford: Oxford University Press.

Montgomery, K. (2006). How Doctors Think: Clinical Judgment and the Practice of Medicine. Oxford: Oxford University Press.

Tonelli, M.R. (2014). Clinical decision making for a person centered medicine: The necessity of casuistic reasoning. European Journal for Person Centered Healthcare 2 (1) 71-75.



  • There are currently no refbacks.