Theoretical Medicine and Bioethics

, Volume 30, Issue 3, pp 215–229 | Cite as

Yearning for certainty and the critique of medicine as “science”

  • Mark H. WaymackEmail author


A debate has simmered concerning the nature of clinical reasoning, especially diagnostic reasoning: Is it a “science” or an “art”? The trend since the seventeenth century has been to regard medical reasoning as scientific reasoning, and the most advanced clinical reasoning is the most scientific. However, in recent years, several scholars have argued that clinical reasoning is clearly not “science” reasoning, but is in fact a species of narratival or hermeneutical reasoning. The study reviews this dispute, and argues that in a theoretical sense, the dispute rests upon a naïve—but very popular—caricature of what constitutes “science reasoning.” But, if the dispute rests upon just such a caricature, why is it so persistent? The study concludes by suggesting that we, as patients and as physicians, have deep psychological tendencies that incline us to adopt the very naïve “science” concept/model of diagnostic reasoning, even if (or when) we understand its inaptness.


Clinical reasoning Clinical science Narrative Hermeneutics 



My particular thanks to Professor Kathryn Montgomery for very helpful comments on an earlier version of this piece.


  1. 1.
    Ladd, John. 1979. Philosophy and medicine. In Changing values in medicine, ed. E. Cassell and M. Siegler, 203–221. Frederick, MD: University Publications of America.Google Scholar
  2. 2.
    Brody, Howard. 2003. Stories of sickness. New York: Oxford University Press.Google Scholar
  3. 3.
    Zaner, Richard. 2004. Conversations on the edge: Narratives of ethics and illness. Washington, DC: Georgetown University Press.Google Scholar
  4. 4.
    Lindemann Nelson, Hilda. 2001. Damaged identities, narrative repair. Ithaca, NY: Cornell University Press.Google Scholar
  5. 5.
    Hunter, Kathryn Montgomery. 1991. Doctors’ stories. Princeton: Princeton University Press.Google Scholar
  6. 6.
    Montgomery, Kathryn. 2006. How doctors think. New York: Oxford University Press.Google Scholar
  7. 7.
    Cassell, Eric. 2003. The nature of suffering and the goals of medicine. New York: Oxford University Press.Google Scholar
  8. 8.
    Leder, Drew. 1990. Clinical interpretation: The hermeneutics of medicine. Theoretical Medicine and Bioethics 11: 9–24.CrossRefGoogle Scholar
  9. 9.
    Lock, James. 1990. Some aspects of medical hermeneutics: The role of dialectic and narrative. Theoretical Medicine 11: 41–50.CrossRefGoogle Scholar
  10. 10.
    Svenaeus, Frederik. 2000. The hermeneutics of medicine and the phenomenology of health. Dordrecht: Kluwer.Google Scholar
  11. 11.
    Hume, David. 1999. In An enquiry concerning human understanding, ed. Tom Beauchamp. Oxford: Oxford University Press.Google Scholar
  12. 12.
    Hume, David. 2000. In A treatise of human nature, ed. David F. Norton and MaryJ Norton. Oxford: Oxford University Press.Google Scholar

Copyright information

© Springer Science+Business Media B.V. 2009

Authors and Affiliations

  1. 1.Department of PhilosophyLoyola University ChicagoChicagoUSA

Personalised recommendations