Cognitive Tools in a Clinical Encounter in Medicine: Supporting Empathy and Expertise in Distributed Systems

This paper examines how, in use, culturally-provided tools can be said to embody knowledge and distribute thinking. It focuses on the routine procedures used by medical professionals to investigate patient complaints and examines explicit and implicit contributions of these conventional procedures to distributed thinking in clinical encounters in medicine. After characterizing these tools, examples of how the tools guide and constrain medical problem solving are provided. The tools support the development and exercise of the routines characteristic of medical expertise, while at the same time preserving the nonroutine, controlled deliberation necessary for sound and ethical medical care. The paper concludes with ways in which the tools' role in thinking can be promoted through medical education, particularly during students' early clinical exposure: (a) Organizing learning experiences that expose the tools' meanings; (b) exploiting the benefits of small group work to promote collaborative and individual competencies in distributed systems; and (c) explicitly utilizing the products of thinking with these tools to further the goals shared by participants in clinical encounters.

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