Evidence-free medicine: forgoing evidence in clinical decision making.

Despite being the central concept to evidence-based medicine (EBM), evidence remains an elusive and controversial notion. Ongoing debates regarding evidence primarily serve to confuse and obfuscate. Examination of the nature of medical decision making without any appeal to evidence reveals a more complete understanding of the optimal practice of clinical medicine. An "evidence-free medicine" allows for the incorporation of a variety of facts and warrants, reasons and reasoning, into clinical decisions. The relative weighting of potentially conflicting warrants for a medical decision comprises the critical process of clinical judgment. Forgoing evidence allows clinical medicine to once again be a personal and prudential undertaking, arising from and focused on the individual patient.