Phronesis is often described as a ‘practical wisdom’ adapted to the matters of everyday human life. Phronesis enables one to judge what is at stake in a situation and what means are required to bring about a good outcome. In medicine, phronesis tends to be called upon to deal with ethical issues and to offer a critique of clinical practice as a straightforward instrumental application of scientific knowledge. There is, however, a paucity of empirical studies of phronesis, including in medicine. (...) Using a hermeneutic and phenomenological approach, this inquiry explores how phronesis is manifest in the stories of clinical practice of eleven exemplary physicians. The findings highlight five overarching themes: ethos (or character) of the physician, clinical habitus revealed in physician know-how, encountering the patient with attentiveness, modes of reasoning amidst complexity, and embodied perceptions (such as intuitions or gut feeling). The findings open a discussion about the contingent nature of clinical situations, a hermeneutic mode of clinical thinking, tacit dimensions of being and doing in clinical practice, the centrality of caring relations with patients, and the elusive quality of some aspects of practice. This study deepens understandings of the nature of phronesis within clinical settings and proposes ‘Clinical phronesis’ as a descriptor for its appearance and role in the daily practice of (exemplary) physicians. (shrink)

The relevance of the Aristotelian concept ofphronesis – practical wisdom – for medicine and medical ethics has been much debated during the last two decades. This paper attempts to show how Aristotle’s practical philosophy was of central importance toHans-Georg Gadamer and to the development of his philosophical hermeneutics, and how,accordingly, the concept of phronesiswill be central to a Gadamerian hermeneutics of medicine. If medical practice is conceived of as an interpretative meeting between doctor and patient with the aim of restoring (...) the health of the latter, then phronesis is the mark of the good physician, who through interpretation comes to know the best thing todo for this particular patient at this particular time. The potential fruitfulness of this hermeneutical appropriation of phronesis for the field of medical ethics is also discussed. The concept can be (and has been) used in critiques of the conceptualization of bioethics as the application of principle-based theory to clinical situations, since Aristotle’s point is exactly that problems of praxis cannot be approached in this way. It can also point theway for alternative forms of medical ethics, such as virtue ethics or a phenomenological andhermeneutical ethics. The latter alternative would have to address the phenomena of healthand the good life as issues for medical practice. It would also have to map out in detail the terrain of the medical meeting and the acts of interpretation through which phronesis is exercised. (shrink)

Shared Decision-Making is a widely accepted model of the physician–patient relationship providing an ethical environment in which physician beneficence and patient autonomy are respected. It acknowledges the moral responsibility of physician and patient by promoting a deliberative collaboration in which their individual expertise—complementary in nature, equal in importance—is emphasized, and personal values and preferences respected. Its goal coincides with Pellegrino and Thomasma’s proximate end of medicine, that is, a technically correct and morally good healing decision for and with a particular (...) patient. We argue that by perfecting the intellectual ability to apprehend the complexity of clinical situations, and through a perfection of the application of the first principles of practical reason, prudence is able to point toward the right and good shared medical decision. A prudent shared medical decision is therefore always in keeping with the kind of person the physician and the patient have chosen to be. (shrink)

This paper compares clinical intuition and phenomenological intuition. I begin with a brief analysis of Husserl’s conception of intuition. Second, I review the attitude toward clinical intuition by physicians and philosophers. Third, I discuss the Aristotelian conception of intellectual intuition or nous and its relation to phronesis. Phronesis provides a philosophical ground for clinical intuition by linking medicine as both a techné and praxis. Considering medicine as a techné, Pellegrino and Thomasma exclude clinical intuitions from their philosophy of medicine. However, (...) in modeling clinical reasoning on phronesis, they link Aristotelian nous with clinical reasoning. While supporting the application of phronesis to clinical reasoning, I consider Pellegrino and Thomasma’s model deficient for eliminating intuition as an inalienable element of clinical reasoning. Rather, clinical intuitions are necessary in linking medicine as both art and practice. This becomes more obvious through the phenomenological analysis of clinical intuitions. Clinical reasoning and phenomenological intuitions are similar in joining the perceptual and intellectual aspects of human judgment. Furthermore, clinical intuitions can be extended to become phenomenological intuitions through phenomenological reflection. Clinical intuitions may be examined phenomenologically for their originary foundations. In this way, medicine acts as a phenomenological clue. Phenomenology provides a method to restore the Hippocratic synthesis of empirical observation and wholism associated with clinical intuitions. (shrink)

The paper explores the relation between reason and action as it emerges from the texts of Āyurveda. Life or Ayus (commonly understood as life-span) is primary subject matter of Ayurveda. Life is a locus of experience, action and disposition. Experiences and actions are differentially determined by dispositions that characterize the organism; otherwise all living organisms will be identical. Ayus of each living being is uniquely individual and remains constant between birth and death. In this journey, upkeep of ayus is the (...) purpose of Āyurveda or science of life. Ayurveda is a science of experienced matter as well as of experienced body. The living body is critically dependent on the influx of matter for its upkeep. Āyurveda offers a conceptual system to reason about balance and imbalances of the system and the causal role of the material flux through the system. This sensate matter is causally open and makes room for definite causal role for the individual and the effective insertion of the felt-purpose of action. Some of the strengths of Ayurveda are brought forth in the paper such as (a) reasoning out the compatibility between the bodily processes and the selection of the natural products for diet and drug, (b) role for heuristics in medical diagnosis, which takes into cognizance the particularity of each living body and the teleology evident in the very act of diagnostic reasoning. The paper shows that Āyurvedic theory is built on experiential datum whereas scientific medical theory is built on experience-independent datum. Āyurveda explores causal efficacy of ‘secondary qualities’ whereas scientific medicine explores causal efficacy of ‘primary qualities’. The actionable experiential reasoning is at the foundations of Āyurveda whereas modern medical science is ab initio saddled with difficult ‘hiatus theoreticus’ between theory and practice. For Ayurveda it is experience of qualities that discloses behavior of matter. The types of qualities that appear in experience have a special significance for theorizing about the actions of matter with the help of qualities. The paper explores the relation between experience of qualities and the method of science. It shows how efficacy of medical practice is based on the foundational stance of experiential realism in theory. To bring the point home, the paper borrows Aristotalian concepts to show how the relation between phantasm and phronesis is honored in the very theory of Āyurveda. (shrink)

The past 10 years have seen considerable developments in the use of narrative in medicine, primarily through the emergence of the so-called narrative medicine. In this article, I question narrative medicine’s self-understanding and contend that one of the most prominent issues is its lack of a clear epistemological framework. Drawing from Gadamer’s work on hermeneutics, I first show that narrative medicine is deeply linked with the hermeneutical field of knowledge. Then I try to identify which claims can be legitimately expected (...) from narrative medicine, and which ones cannot be. I scrutinize in particular whether narrative medicine can legitimately grasp the patient’s lived experience of his or her illness. In the last section of this article, I begin to explore the potential usefulness of this epistemological clarification. This analysis allows for a further understanding of what is really at stake with narrative medicine, and thus to identify when it may be convenient, and when it may not. Furthermore, this clarification opens up promising new possibilities of dialogue with critics of the field. I conclude that narrative medicine finds its proper place as a possible tool available to mediate dialogue, which is at the heart of the clinical encounter in medical practice. (shrink)

The increasing impact of technology on health care has raised some important questions. This study is undertaken to examine how the predominance of a scientific approach to medicine and health care undermines other crucial aspects of the relationship between patients and care givers.