This is the last in a series of five articles on narrative based medicine

In a widely quoted riposte to critics who accused them of naive empiricism, Sackett and colleagues claimed that “the practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence By individual clinical expertise we mean the proficiency and judgment that individual clinicians acquire through clinical experience and clinical practice.”1 Sackett and colleagues were anxious to acknowledge that there is an art to medicine as well as an objective empirical science but they did not attempt to define or categorise the elusive quality of clinical competence. This article explores the dissonance between the “science” of objective measurement2 and the “art” of clinical proficiency and judgment,3^–5 and attempts to integrate these different perspectives on clinical method.