So, is the glass half empty or half full?

You point to “evidence” suggesting that physician clinical decision making skills (gut judgement) have declined over the past few decades…and that this results in incorrect diagnoses.

Has this been offset — or perhaps more than offset — by the rise in ebm (science, evidence, using the head)? of course, we have no way of measuring this, but its a question worth considering.

And it probably it is something that could be measured going forward. What’s the relative value of physician time spent on gut judgement vs. ebm type activities.

The distinction between using clinical skills vs. ebm/diagnostic skills strikes me as a false dichotomy. The goal should be optimizing the use of both, rather than maximizing the use of one or the other. Adding patient input only enriches the probability of a “correct” diagnosis.

I prefer to view the glass as half full, and getting fuller day by day.