Ways of Knowing, Learning, and Developing

Michael Polanyi, a scientist and philosopher, explored the concept of knowledge in great detail, only to conclude that knowledge is always personal [1]. We content that embracing this view of knowledge will expand on Stange’s thoughtful elaborations [2] based on Schumacher’s and Wilber’s “dimensions of knowledge” resulting in a coherent dynamically interconnected knowledge, learning and development framework.

Based on the Cynefin framework of sense-making [3], we have previously shown that knowledge in medicine [4] resides in one of four domains determined by the “knower’s” context and approach. Linking the personal with the contextual understanding of knowledge the following picture emerges. In general terms for an anatomist or pathologist things are clear because “I know as I – and anybody else – can see it”; for a doctor focusing on one part of the body things are largely clear “I know as these facts add up to ...”; for the generalist things are clear in a strong but fuzzy sense “I know as these things fit, or don’t fit, a pattern I’ve seen before”; while the emergency physician “knows that without doing something in a crisis I won’t see what is what and where things are going to head.”

Applying the above to Stange’s Sophia who suddenly requires treatment for ketoacidosis will allow each of these four types of health professionals to provide an answer starting with “I know that ...”, however no statement will have unequivocal authority. From a complexity perspective on knowledge, learning and developing, all provide a particular perspective on the interconnected components and their dynamic behaviour. Sharing these perspectives facilitates ‘new’ knowledge generation; sharing will result in each professional expanding their “personal knowledge”, and iteratively each will expand their “I know ...” – from the micro-detail of the research scientist to the macro-detail of the epidemiologist – through subsequent meetings around the problem.

From a complexity perspective knowledge is never finite, and knowledge is always content AND context sensitive; knowledge reflects patterns, not detail, and knowledge is only ‘concrete as required’ in this situation at this point in time; knowledge is about being able to adapt and cope in a changing environment. For patients knowledge about their illness means the integration and sense-making of the experiences of illness in their particular circumstance [5].

The wisdom of understanding knowledge as complex leads to wise council that gives patients the wisdom to manage their illness with knowledge.

1. Polanyi, M., Personal Knowledge. Towards a Post-Critical Philosophy. 1958, London: Routledge.
2. Stange, K.C., Ways of Knowing, Learning, and Developing. Annals of Family Medicine. 2010;8(1):4-10.
3. Kurtz, C.F. and D.J. Snowden, The new dynamics of strategy: Sense-making in a complex and complicated world. IBM Systems Journal. 2003;42(3):462-483.
4. Sturmberg, J.P. and C.M. Martin, Knowing - in Medicine. Journal of Evaluation in Clinical Practice. 2008;14(5):767-770.
5. Sturmberg, J.P., The personal nature of health. Journal of Evaluation in Clinical Practice. 2009;15(4):766-769.

Competing interests:   None declared