Medical Thinking

How doctors think is an important issue for many healthcare professionals, especially in terms of cognitive mistakes and errors, and is a title of two recent books (Montgomery, 2006; Groopman, 2007). Biomedical practitioners generally subscribe to an objective way of thinking or reasoning that takes science as its example of how best to obtain and substantiate knowledge. Such knowledge is impersonal and has been described as “the view from nowhere” (Nagel, 1989).1 In other words, this knowledge is applicable and valid for all times and places, regardless of one’s particular values or biases or cultural context. Objective thinking brackets the emotions and intuitions, which proponents claim distort our knowledge of the world. “Intuitive thinking, brainstorming, creative option generation, and open-ended questions,” for the biomedical practitioner according to Davis-Floyd and St. John, “are usually taboo” (1998, p. 33).

Humanistic or humane practitioners, although recognizing the significance and value of objective knowledge for medical practice, subscribe to a subjective way of thinking and reasoning that includes the intuitions, values, and virtues of the knower. Importantly, this type of thinking, especially in medicine, is based on the patient’s narrative of the illness experience, as well on the physician’s personal narrative of what it means to be a healer. In this chapter, I discuss objective thinking and reasoning in terms of the debate over the empirical and rational justification of knowledge and with respect to the logical nature of knowing. The subjective way of thinking and reasoning is discussed in terms of intuitions, values, and virtues, as well as narrative. In this way of thinking, humane practitioners address the quality-of-care crisis.