Document Detail

Thinking about thinking: implications for patient safety.
MedLine Citation:
PMID:  19667768     Owner:  NLM     Status:  MEDLINE    
Clinical medicine, a learned, rational, science-using practice, is labelled a science even though physicians have the good sense not to practise it that way. Rather than thinking like scientists - or how we think scientists think - physicians are engaged in analogical, interpretive reasoning that resembles Aristotle's phronesis, or practical reasoning, more closely than episteme, or scientific reasoning. In medicine, phronesis is clinical judgment; and while it depends on both a fund of information and extensive experience, somehow it is not quite teachable. This practical, clinical rationality relies on case narrative for teaching and learning about illness and disease, for recording and communicating about patient care and, inevitably, for thinking about and remembering the details, as well as the overarching rules of practice. At the same time, "anecdotal" remains the most pejorative word in medicine, and the tension between the justifiable caution this disdain expresses and the pervasive narrative structure of medical knowledge is characteristic of clinical knowing generally: a tug-of-war between apparent irreconcilables that can be settled only by an appeal to the circumstances of the clinical situation. Practical rationality in the clinical encounter is characterized by a productive circulation between the particular details of the patient's presentation and general information about disease stored as a taxonomy of cases. Evidence-based medicine can improve this negotiation between general knowledge and the patient's particulars, but it cannot replace it. In a scientific era, clinical judgment remains the quintessential intellectual strength of the clinician. Why, then, do we not teach the epistemology of medicine? Understanding the mis-description of physicians' thinking - and the accompanying claim that medicine is, in itself, a science - could mitigate the misplaced perfectionism that makes mistakes in medicine personal and unthinkable.
Kathryn Montgomery
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Healthcare quarterly (Toronto, Ont.)     Volume:  12 Spec No Patient     ISSN:  1710-2774     ISO Abbreviation:  -     Publication Date:  2009  
Date Detail:
Created Date:  2009-08-11     Completed Date:  2009-11-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101208192     Medline TA:  Healthc Q     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  e191-4     Citation Subset:  H    
Northwestern University's Feinberg School of Medicine, Chicago, Illinois, USA.
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MeSH Terms
Medical Errors / prevention & control
Safety Management*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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