The practice of health care: Wisdom as a model

  • Ricca Edmondson
  • Jane Pearce
Scientific Contribution


Reasoning and judgement in health care entail complex responses to problems whose demands typically derive from several areas of specialism at once. We argue that current evidence- or value-based models of health care reasoning, despite their virtues, are insufficient to account for responses to such problems exhaustively. At the same time, we offer reasons for contending that health professionals in fact engage in forms of reasoning of a kind described for millennia under the concept of wisdom. Wisdom traditions refer to forms of deliberation which combine knowledge, reflection and life experience with social, emotional and ethical capacities. Wisdom is key in dealing with problems which are vital to human affairs but lack prescribed solutions. Uncertainty and fluidity must be tolerated in seeking to resolve them. We illustrate the application of wisdom using cases in psychiatry, where non-technical aspects of problems are often prominent and require more systematic analysis than conventional approaches offer, but we argue that our thesis applies throughout the health care field. We argue for the relevance of a threefold model of reasoning to modern health care situations in which multifaceted teamwork and complex settings demand wise judgement. A model based on practical wisdom highlights a triadic process with features activating capacities of the self (professional), other (patient and/or carers and/or colleagues) and aspects of the problem itself. Such a framework could be used to develop current approaches to health care based on case review and experiential learning.


evidence-based medicine experiential learning health care practitioners judgement multi-disciplinary team practical wisdom psychiatrist values wisdom wise reasoning 


  1. Ardelt M. (1997) Wisdom and Life Satisfaction in Old Age. J Gerontol 52B(1):15–27Google Scholar
  2. Baltes P.B. (1993) The Aging Mind: Potential and Limits. Gerontologist 33:580–594PubMedGoogle Scholar
  3. Baltes P.B., Staudinger U. (2000) Wisdom: A Metraheuristic (Pragmatic) to Orchestrate Mind and Virtue Toward Excellence. American Psychologist 55(1):122–136CrossRefPubMedGoogle Scholar
  4. Clayton V.P., Birren J.E. (1980) The development of wisdom across the life-span: A reexamination of an ancient topic. In: Baltes P.B., Brim O.G. (eds), Life-Span Development and Behavior vol 3. Academic Press, New York, pp 103–135Google Scholar
  5. Coulter A. (2002) ‘Patients’ Views of the Good Doctor’. BMJ 325:668–669CrossRefPubMedGoogle Scholar
  6. Dittman-Kohli F., Baltes P.B. (1990) Toward a neofunctionalist conception of adult intellectual development: Wisdom as a prototypical case of intellectual growth. In: Alexander C., Langer E. (eds), Higher Stages of Human Development: Perspectives on Adult Growth. Oxford University Press, New York, pp 54–78Google Scholar
  7. Dixon T. (2003) From Passions to Emotions: The Creation of a Secular Psychological Category. Cambridge University Press, CambridgeGoogle Scholar
  8. Edmondson R. (1984) Rhetoric and Sociology. Macmillan, LondonGoogle Scholar
  9. Edmondson R. (2005) Wisdom in later life: Ethnography approaches. Ageing and Society 25:339–356CrossRefGoogle Scholar
  10. Edmondson R. (2007) Rhetorics of Social Science: Sociality in Writing and Inquiry, to appear. In: William Outhwaite and Stephen P. Turner (eds), Handbook of Social Science Methodology. Sage, Thousand Oaks, CAGoogle Scholar
  11. Edmondson, R. and M.H. Woerner: forthcoming, Crises of Wisdom.Google Scholar
  12. Fulford K.W.M. (2004) Ten Principles of Values-Based Medicine. In: Radden J. (eds), The Philosophy of Psychiatry: A Companion. Oxford University Press, New York, pp 205–234Google Scholar
  13. Hare R.M. (1963) Freedom and Reason. Oxford University Press, OxfordGoogle Scholar
  14. Holliday S., Chandler M. (1986) Wisdom: Explorations in Adult Competence (Contributions to Human Development 17). Karger, BaselGoogle Scholar
  15. Kramer D.A., et al. (1992) A Measure of Paradigm Beliefs About the Social World. Journal of Gerontology 47(3):180–189Google Scholar
  16. Lown B. (1996) The Lost Art of Healing. Ballantine Books, New YorkGoogle Scholar
  17. Meacham J.A. (1990) The Loss of Wisdom. In: Sternberg R.J. (eds), Wisdom: Its Nature, Origins and Development. Cambridge University Press, Cambridge, pp 181–211Google Scholar
  18. Oser F.K., et al. (1999) Wisdom: an action-oriented approach. In: Reich K.H., Oser F.K., Scarlett W.G. (eds), Psychological Studies on Spiritual and Religious Development. Leugerich, Pabst, pp 105–21Google Scholar
  19. Paice E., et al. (2002) The relationship between pre-registration house officers and their consultants. Medical Education 36:26–34CrossRefPubMedGoogle Scholar
  20. Parker M. (2002) Whither our art? Clinical wisdom and evidence-based medicine. Medicine, Health Care and Philosophy 5:273–280CrossRefGoogle Scholar
  21. Pearce J. (2002) Systemic Therapy. In: Hepple J., Pearce J., Wilkinson P. (eds), Psychological Therapies with Older People: Developing Treatments for Effective Practice. Brunner-Routledge, Hove, pp 76–102Google Scholar
  22. Plesk P.E., Greenhalgh T. (2001) The Challenge of Complexity in Health Care. BMJ. 323:625–628CrossRefGoogle Scholar
  23. Rad G von (1972) Wisdom in Israel (trans. J. Martin; German edition 1970) Harrisburg. Trinity Press International, PennsylvaniaGoogle Scholar
  24. Sackett D.L., et al. (1996) Evidence based medicine: what it is and what it isn’t. BMJ. 312:71–72PubMedGoogle Scholar
  25. Sackett D.L., et al. (1991) Clinical Epidemiology: A Basic Science for Clinical Medicine. Little Brown, LondonGoogle Scholar
  26. Sinclair S., (1997) Making Doctors: An Institutional Apprenticeship. Berg, OxfordGoogle Scholar
  27. Staudinger U., Baltes P. (1996) Interactive Minds: A Facilitative Setting for Wisdom-Related Performance?. Journal of Personality and Social Psychology 71(4):746–762CrossRefGoogle Scholar
  28. Staudinger U., et al. (1998) What Predicts Wisdom-Related Performances? A First Look at Personality, Intelligence, and Facilitative Experiential Contexts. European Journal of Personality 13:1–17CrossRefGoogle Scholar
  29. Sternberg R.J. (1985) Implicit theories of Intelligence, Creativity, and Wisdom. Journal of Personality and Social Psychology 49:607–627CrossRefGoogle Scholar
  30. Sternberg R.J., (eds), (1990) Wisdom: Its Nature, Origins and Development. Cambridge University Press, CambridgeGoogle Scholar
  31. Woerner M.H. (1990) Das Ethische in der Rhetorik des Aristoteles. Alber, Freiburg/Br.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2006

Authors and Affiliations

  1. 1.Political Science and SociologyNational University of Ireland GalwayGalwayIreland

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