SeriesThe art and science of clinical knowledge: evidence beyond measures and numbers
Section snippets
The nature of clinical knowledge
Clinical practice might be an expression of systematic and critical assessment, continuous experimentation, and subsequent revision of knowledge in which informal norms and implicit algorithms are available for deliberation.3 Yet, although the ideas of the critical clinical school and evidence-based medicine are widely accepted, controlled experiments are rarely the sole basis on which clinical decisions are made.4, 5 When knowledge is applied to the individual patient, the logic of affirmation
The art of medicine
According to Polanyi,26 human knowing is characterised by the fact that we know more than we can impart. A person, for example, might be able to do complicated actions, constituting comprehensive knowledge, though at the same time be unable to explain their actions. The ability to identify many small factors and to see how they fit together as a whole is fundamental for this kind of practical understanding. Polanyi refers to the art of diagnosing as an example of skilful testing and expert
Qualitative research
Qualitative research methods, also called naturalistic inquiry,32, 33 were developed within the social and human sciences, and refer to theories on interpretation (hermeneutics) and human experience (phenomenology). They include various strategies for systematic collection, organisation, and interpretation of textual material obtained by talking with people or through observation. The aim of such research is to investigate the meaning of social phenomena as experienced by the people themselves.
Qualitative research in medicine
Qualitative research methods are now being used in the field of medicine.1, 40 Several studies of varying quality have been published over the past years, some by highly reputable medical journals. Research into health services often applies methodologies from anthropology (eg, participant observation) or psychology (eg, in-depth interviews).35, 41 Qualitative studies on communication and doctor-patient interaction8, 9, 10, 25, 30 have been presented from general practice research.
References (43)
The interpretive turn
Lancet
(1995)- et al.
Scientific uncertainty and medical responsibility
Theor Med
(1987) The role of some nonbiomedical parameters in clinical decision making: an ethnographic approach
Qual Health Res
(1991)Rational diagnosis and treatment
J Med Philos
(1986)- et al.
Evidence-based medicine: how to practice and teach EBM
(1997) The reflective practitioner: how professionals think in action
(1991)- et al.
General practitioner perceptions of low back patients
Fam Pract
(1995) Routine, ceremony, or drama: an exploratory study of the primary care clinical encounter
J Fam Pract
(1992)- et al.
New gateways to dialogue in general practice: development of an illness diary to expand communication
Scand J Prim Health Care
(1997) - et al.
Encouraging the strengths of women patients: a case study from general practice on empowering dialogues
Scand J Public Health
(1999)
The patient-centred clinical method: 1 A model for the doctor-patient interaction in family medicine
Fam Pract
The reliability of clinical methods, data and judgments
N Engl J Med
Variability in radiologists' interpretation of mammograms
N Engl J Med
Laboratory life: the construction of scientific facts
Subjectivity in data analysis
Lancet
The (gendered) construction of medical diagnosis: interpretation of symptoms and signs in female patients
Theor Med Bioethics
Clinical interpretation: the hermeneutics of medicine
Theor Med
The challenge to biomedicine: a foundations perspective
J Med Philos
Doctors' stories: the narrative structure of medical knowledge
“An acquaintance with particulars…”
Fam Med
Explaining risk factors to patients during a general practice consultation: conveying group-based epidemiological knowledge to individual patients'
Scand J Prim Health Care
Cited by (580)
Perspectives on unhealthy alcohol use among men who have sex with men prescribed HIV pre-exposure prophylaxis: A qualitative study
2024, Preventive Medicine ReportsChanging patterns of the grammatical stance devices in medical research articles (1970–2020)
2023, Journal of English for Academic PurposesSustained practice of Qigong results in a somatic hermeneutic process, contributing to appreciation of life. An interpretative phenomenological analysis
2023, Journal of Bodywork and Movement TherapiesThe Provider's Role in Retaining Black Women With HIV in Care: A Scoping Review
2024, Journal of the International Association of Providers of AIDS Care