Advertisement

Theoretical Medicine and Bioethics

, Volume 30, Issue 3, pp 231–247 | Cite as

Wisdom in clinical reasoning and medical practice

  • Ricca EdmondsonEmail author
  • Jane Pearce
  • Markus H. Woerner
Article

Abstract

Exploring informal components of clinical reasoning, we argue that they need to be understood via the analysis of professional wisdom. Wise decisions are needed where action or insight is vital, but neither everyday nor expert knowledge provides solutions. Wisdom combines experiential, intellectual, ethical, emotional and practical capacities; we contend that it is also more strongly social than is usually appreciated. But many accounts of reasoning specifically rule out such features as irrational. Seeking to illuminate how wisdom operates, we therefore build on Aristotle’s work on informal reasoning. His account of rhetorical communication shows how non-formal components can play active parts in reasoning, retaining, or even enhancing its reasonableness. We extend this account, applying it to forms of healthcare-related reasoning which are characterised by the need for wise decision-making. We then go on to explore some of what clinical wise reasoning may mean, concluding with a case taken from psychotherapeutic practice.

Keywords

Wisdom Clinical reasoning Healthcare-professional judgement 

References

  1. 1.
    Edmondson, R. 2005. Wisdom in later life: Ethnographic approaches. Ageing in Society 25: 339–356.CrossRefGoogle Scholar
  2. 2.
    Edmondson, Ricca, and Jane Pearce. 2007. The practice of health care: Wisdom as a model. Medicine, Health Care and Philosophy 10 (3): 233–244.CrossRefGoogle Scholar
  3. 3.
    Geva-May, Iris. 2007. “We seem to have always spoken in prose…” Policy analysis is a clinical profession: Implications for policy analysis practice and instruction. Policy Studies Journal 35 (2): 135–164.CrossRefGoogle Scholar
  4. 4.
    Simon, Herbert A. 1956. Rational choice and the structure of the environment. Psychological Review 63 (2): 129–138.CrossRefGoogle Scholar
  5. 5.
    Norman, Geoffrey R., and Henk G. Schmidt. 1999. The psychological basis of problem-based learning: A review of the evidence. In Problemorientierte Medizinerausbildung in München, ed. Hans Zehetmair and Klaus Peter, 139–157. Munich: Hanns-Seidel-Stiftung. Reprint of 1992 article in Academic Medicine 67: 557–565Google Scholar
  6. 6.
    Dochy, Filip, Mien Segers, Piet van den Bossche, and David Gijbels. 2003. Effects of problem-based learning: A meta-analysis. Learning and Instruction 13 (5): 533–568.CrossRefGoogle Scholar
  7. 7.
    Wortberg, Walter. 2008. Environmental medicine and health in industrialised nations: Cases from Germany. In Environmental argument and cultural difference: Locations, fractures and deliberations, ed. Ricca Edmondson, and Henrike Rau, 233–258. Oxford: Peter Lang.Google Scholar
  8. 8.
    Double, D.D. 2006. Clinician bias in diagnosis and treatment. In The power of belief: Psychosocial influence on illness, disability and medicine, ed. P. Halligan, and M. Aylward, 189–204. Oxford: Oxford University Press.Google Scholar
  9. 9.
    Egidi, Massimo. 2003. Discrepancies: Competing theories and ideologies as cultural traps. In Cognitive developments in economics, ed. Salvatore Rizzello, 20–52. London: Routledge.Google Scholar
  10. 10.
    Elstein, Arthur S. 2000. Clinical problem solving and decision psychology: Comment on the epistemology of clinical reasoning. Academic Medicine 75 (10): 134–139.CrossRefGoogle Scholar
  11. 11.
    Higgs, Joy, Mark Jones, Stephen Loftus, Nicole Christiansen, ed. 2000. Clinical reasoning in the health professions, 2nd ed. London: Butterworth-Heinemann.Google Scholar
  12. 12.
    Fulford, K.W.M. 2004. Ten principles of values-based medicine. In The philosophy of psychiatry: A companion, ed. J. Radden, 205–234. New York: Oxford University Press.Google Scholar
  13. 13.
    Stempsey, William E. 2000. Disease and diagnosis: Value-dependent realism. Dordrecht: Kluwer.Google Scholar
  14. 14.
    Aristotle. 1984. Nichomachean ethics. In The complete works of Aristotle: The revised Oxford translation, Vol. 2, 1729–1867 (trans: Jonathan Barnes). Princeton: Princeton University Press.Google Scholar
  15. 15.
    Edmondson, Ricca. 1984. Rhetoric in sociology. London: Macmillan.Google Scholar
  16. 16.
    Woerner, Markus H. 1990. Das rthische in der Rhetorik des Aristoteles. Freiburg/Br: Alber Verlag.Google Scholar
  17. 17.
    Edmondson, Ricca. 2007. Rhetorics of social science: Sociality in writing and inquiry. In The handbook of social science methodology, ed. William Outhwaite, and Stephen Turner, 479–498. London: Sage.Google Scholar
  18. 18.
    Aristotle. 1945. Rhetorica (trans: Roberts, W. Rhys). Oxford: Clarendon Press.Google Scholar
  19. 19.
    Aristotle. 1965. Prior and posterior analytics (rev. text with introduction and commentary by W.D. Ross). Oxford: Clarendon Press.Google Scholar
  20. 20.
    Woerner, Markus H. 1982. Enthymeme—Ein rückgriff auf Aristoteles in systematischer absicht. In Rhetorische rechsttheorie, ed. Ottmar Ballweg, and Thomas-Michael Seibert, 73–98. Freiburg/Br: Alber Verlag.Google Scholar
  21. 21.
    Burnyeat, Myles. 1994. Enthymeme: Aristotle on the logic of persuasion. In Aristotle’s rhetoric: Philosophical essays, proceedings of the 11 th symposium Aristotelicum, ed. D.J. Furley, and A. Nehamas, 3–55. Princeton: Princeton University Press.Google Scholar
  22. 22.
    Lynn, Lawrence E. 1996. Public management as art, science, and profession. Chatham, NJ: Chatham House.Google Scholar
  23. 23.
    Lynn, Lawrence E. 1999. Teaching and learning with cases. New York: Chatham House.Google Scholar
  24. 24.
    Sackett, David L., R.B. Haynes, P. Tugwell, and G. Guyatt. 1991. Clinical epidemiology: A basic Science for clinical medicine. London: Little Brown.Google Scholar
  25. 25.
    Edmondson, Ricca. 2008. Wisdom and older people in Ireland. Senior People Education Studies (Wuhan, China) 2 (36): 73–76.Google Scholar
  26. 26.
    Sternberg, Robert J. 1998. A balance theory of wisdom. Review of General Psychology 2: 347–365.CrossRefGoogle Scholar
  27. 27.
    Baltes, Paul, and Ursula Staudinger. 2000. Wisdom: A metaheuristic (pragmatic) to orchestrate mind and virtue toward excellence. American Psychologist 55: 122–135.CrossRefGoogle Scholar
  28. 28.
    Schon, Donald. 1983. The reflective practitioner: How professionals think in action. Aldershot: Ashgate.Google Scholar
  29. 29.
    Lauder, W. 1994. Beyond reflection: Practical wisdom and the practical syllogism. Nurse Education Today 14 (2): 91–96.CrossRefGoogle Scholar
  30. 30.
    Coles, Colin. 2002. Developing professional judgment. Journal of Continuing Education in the Health Professions 22 (1): 3–10.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2009

Authors and Affiliations

  • Ricca Edmondson
    • 1
    Email author
  • Jane Pearce
    • 2
  • Markus H. Woerner
    • 3
  1. 1.School of Political Science and SociologyNational University of Ireland, GalwayGalwayIreland
  2. 2.The Fulbrook CentreThe Churchill Hospital, Oxfordshire and Buckinghamshire Mental Health NHS Foundation TrustOxfordUK
  3. 3.Department of PhilosophyNational University of Ireland, GalwayGalwayIreland

Personalised recommendations