Elsevier

The Lancet

Volume 358, Issue 9279, 4 August 2001, Pages 397-400
The Lancet

Series
The art and science of clinical knowledge: evidence beyond measures and numbers

https://doi.org/10.1016/S0140-6736(01)05548-9Get rights and content

Summary

Medical doctors claim that their discipline is founded on scientific knowledge. Yet, although the ideas of evidence based medicine are widely accepted, clinical decisions and methods of patient care are based on much more than just the results of controlled experiments. Clinical knowledge consists of interpretive action and interaction—factors that involve communication, opinions, and experiences. The traditional quantitative research methods represent a confined access to clinical knowing, since they incorporate only questions and phenomena that can be controlled, measured, and counted. The tacit knowing of an experienced practitioner should also be investigated, shared, and contested. Qualitative research methods are strategies for the systematic collection, organisation, and interpretation of textual material obtained from talk or observation, which allow the exploration of social events as experienced by individuals in their natural context. Qualitative inquiry could contribute to a broader understanding of medical science.

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.

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