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The undercurrent argument at the CICM ASM has been based on the tension between the artist and the scientist. It has been good natured, and an interesting topic for reflection. The scientist, hyperrationalist, trialist, evidence based clinician, believes everything should be tested, ideally proven by RCT. The criticism leveled at them is their inability to separate out poor quality evidence, lack of clinical nous, and susceptibility to drowning in "a sea of bullshit", like the epidemic of meta-analysis. The artist, heuristic thinker, common sense based clinician believes that experience tells us a lot, it doesn't all have to be proven. Heuristic thinking refers to an experience based approach to problem-solving and learning, or a common-sense approach. It is based on trial and error, and is generally sensible. However it can lead to systematic errors, and cognitive bias. "Wrong sometimes in darkness never".  Est modus in rebus  (there is a middle ground) ?  Are we as a critical care society failing to engage these competing models? Heuristic thinking is embedded in medicine. We all evolve from our days as medical students to senior consultants.  From slowly accumulating as much information about a patient as possible before struggling to interpret it, we become efficient decision-makers. This learning curve and evolution is through internal application of trial and error to develop and test models of illness. This does lead to the risk of systematic error and bias creeping into our heuristic models unchallenged.  The introduction of evidence based medicine into this clinical decision making model may help prevent this. For this to be successful clinicians need to be able to acquire, interpret and appropriately introduce evidence into practice. Presumably in situations where a clinician finds evidence conflicts with their heuristic model, they need to actively resolve the conflict. There is a need for heuristic thinking, ie clinical judgement, but the rules we learn from large populations provide may provide a safe "playing field" in which to practice in.  Combining the two may define a good clinician?