An Epistemology For Clinical Medicine: An Argument for Reflection on the Ends of Medical Practice and Ways of Knowing With Implications for the Selection and Training of Physician

摘要

Today physicians and scientists have a detailed understanding of human biology and have developed diagnostic and therapeutic tools that were unimaginable a century ago. Yet physicians have provided care and counsel for more than 3000 years. Some, such as Hippocrates and Osler, remain exemplars of the excellent physician. They did not have our scientific knowledge or tools, but they knew something important and performed some task of great value to their patients. What did they know and what did they do? This article explores the questions every ill patient asks, the timeless nature of patient as person, and the forms of non-factual knowing (described as know-how, know-what, know-who, and know-how-it-feels) that are essential to patient care. From this, it is suggested that the combination of understanding, insight, and judgment used for practical action, what Aristotle called “phronesis,” is the core competency of excellent physicians which has remained unchanged across the centuries.