The legitimacy of clinical knowledge: Towards a medical epistemology embracing the art of medicine

The traditional medical epistemology, resting on a biomedical paradigmatic monopoly, fails to display an adequate representation of medical knowledge. Clinical knowledge, including the complexities of human interaction, is not available for inquiry by means of biomedical approaches, and consequently is denied legitimacy within a scientific context. A gap results between medical research and clinical practice. Theories of knowledge, especially the concept of tacit knowing, seem suitable for description and discussion of clinical knowledge, commonly denoted “the art of medicine.” A metaposition allows for inquiry of clinical knowledge, inviting an expansion of the traditional medical epistemology, provided that relevant criteria for scientific knowledge within this field are developed and applied. The consequences of such approaches are discussed.

[1]  E Gatens-Robinson,et al.  Clinical judgment and the rationality of the human sciences. , 1986, The Journal of medicine and philosophy.

[2]  E. Pellegrino Philosophy of Medicine: problematic and potential. , 1976, The Journal of medicine and philosophy.

[3]  Donald A. Schön,et al.  The Reflective Practitioner: How Professionals Think in Action. , 1987 .

[4]  Hubert L. Dreyfus,et al.  Putting Computers in Their Place , 1980 .

[5]  Mcwhinney Ir Are we on the brink of a major transformation of clinical method , 1986 .

[6]  M. Polanyi Chapter 7 – The Tacit Dimension , 1997 .

[7]  池見 酉次郎 Michael Balint, M. D. 著, The docter, his patient and the illness(実地医家のための心理療法入門), (Pitman Medical Publishing Co. Ltd. London) , 1967 .

[8]  Donald E. Polkinghorne,et al.  Methodology for the Human Sciences: Systems of Inquiry , 1984 .

[9]  I. McWHINNEY,et al.  Medical knowledge and the rise of technology. , 1978, The Journal of medicine and philosophy.

[10]  C. Helman The role of context in primary care. , 1984, The Journal of the Royal College of General Practitioners.

[11]  K. Malterud Key questions--a strategy for modifying clinical communication. Transforming tacit skills into a clinical method. , 1994, Scandinavian journal of primary health care.

[12]  M BALINT,et al.  The doctor, his patient, and the illness. , 1957, Lancet.

[13]  I. Widdershoven-Heerding Medicine as a form of practical understanding , 1987, Theoretical medicine.

[14]  The concept of practice in Wittgenstein's later philosophy , 1988 .

[15]  T. Kuhn The Structure of Scientific Revolutions. , 1964 .

[16]  The Role of Some Nonbiomedical Parameters in Clinical Decision Making: An Ethnographic Approach , 1991 .

[17]  I R McWhinney,et al.  'An acquaintance with particulars...'. , 1989, Family medicine.

[18]  E. Pellegrino,et al.  For the Patient's Good: The Restoration of Beneficence in Health Care , 1988 .

[19]  M. Grodin,et al.  Scientific uncertainty and medical responsibility , 1987, Theoretical medicine.

[20]  C H McGuire,et al.  Medical problem-solving: a critique of the literature. , 1985, Journal of medical education.

[21]  B. Latour,et al.  Laboratory Life: The Construction of Scientific Facts , 1979 .

[22]  Donald E. Polkinghorne,et al.  Methodology for the human sciences , 1983 .

[23]  Feinstein Ar,et al.  An analysis of diagnostic reasoning. II. The strategy of intermediate decisions. , 1973 .

[24]  A. Tversky,et al.  Judgment under Uncertainty: Heuristics and Biases , 1974, Science.

[25]  Michael D. Resnik,et al.  Reasoning in Medicine: An Introduction to Clinical Inference , 1988 .

[26]  R. Munson Why medicine cannot be a science. , 1981, The Journal of medicine and philosophy.

[27]  D E Detmer,et al.  Heuristics and biases in medical decision-making. , 1978, Journal of medical education.

[28]  E. Keller Reflections on Gender and Science , 1985 .

[29]  Samuel Gorovitz,et al.  Toward a Theory of Medical Fallibility , 1976 .

[30]  H. Wulff,et al.  Rational diagnosis and treatment. , 1986, The Journal of medicine and philosophy.