Knowledge sources informing clinical judgement

Clinical judgements underpinning care planning will draw on the different types of knowledge available. This includes empirical, aesthetic, ethical, personal and practical (Titchen and Ersser, 2001).

Empirical knowledge refers to scientific, technical or factual knowledge. This embraces research evidence including that from a systematic review to inform treatment choices or the selection of more effective methods to provide patient education. It also includes theoretical knowledge, such as those regarding the pharmacological action of drugs, which may influence judgements about the effective drug administration and, for example, ways to improve the absorption of a topical medication. Empirical knowledge is fundamental to the assessment process in which formalised knowledge has been categorised to aid systematic clinical assessment of the skin. Such knowledge provides the rational basis for explaining disease and its progression through, say, genetic, immunological or wider biological or pathological principles. Similarly, the behavioural sciences may explain social withdrawal due to poor self-esteem, how stress and anxiety may provoke a flare of a chronic skin condition or explain the inability of a person to cope with their self-management regime.

Personal knowledge or knowledge of self has been highlighted earlier in the discussion of effective consultation skills. Awareness is required of one’s own individual perceptions, prejudices and bias shaped by own professional and personal history. These factors can lead to precipitant judgements on assessment and patient care.

Aesthetic knowledge refers to that knowledge that relies on an individualised appraisal of a unique situation – searching for patterns in the situation. This is based on how experienced clinicians formulate intuitive hunches on clinical situations and know how to mediate between empirical, practical and personal knowledge in the complex world of professional practice, using all the senses (Eisner, 1985; Titchen and Ersser, 2001). Experience can of course provide a template to aid recognition of similar assessment or treatment situations (such as the early recognition of infected atopic eczema) but this can also close off options for consideration. In the dermatological field, with the considerable number of dermatological diagnoses, it is probable that clinicians will typically gravitate to the common diagnostic groupings discussed earlier in this section. Intuitive impressions can be verified against empirical knowledge to better inform and explain clinical judgements.


Practical knowledge or ‘know how’ embraces skills such as those of a consultation, providing effective dressing or bandaging techniques. Here it is important to assess patient and carer or parental skills to manage their condition or that of their family member. One example would involve assessing if the patient is correctly utilising the appropriate topical medications and finding useful ways of supporting the person with a skin condition. Specifically, it is often necessary to assess both one’s own and the patient’s insight into their self-management and which knowledge and skills need to be developed.