This article is intended to revive, through a critical reinterpretation, the bio-psychosocial model of George Engel. Engel’s first description in 1977, was very broad, encompassing too many aspects of medicine. In his later work, he focused his model as an epistemology for clinical medicine. However, what medicine mostly retained were minor aspects of the 1977 article, namely a multi-factorial approach to the etiology of diseases and a call to complement biomedicine with a psychosocial concern in order to re-humanize medicine. We (...) suggest that, properly understood as a clinical epistemology, Engel’s model retains its transformative potential for contemporary medicine.Our discussion begins with a.. (shrink)

In order to understand the lived experiences of physicians in clinical practice, we interviewed eleven expert, respected clinicians using a phenomenological interpretative methodology. We identified the essence of clinical practice as engagement. Engagement accounts for the daily routine of clinical work, as well as the necessity for the clinician to sometimes trespass common boundaries or limits. Personally engaged in the clinical situation, the clinician is able to create a space/time bubble within which the clinical encounter can unfold. Engagement provides an (...) account of clinical practice as a unitary lived experience. This stands in stark contrast to the prevailing notion, referred to as a dual discourse, that describes medicine as the addition of humanism to science. Drawing on Aristotle’s notion of phronesis and Sartre’s definition of the situation, we illustrate how this novel perspective entwines clinical practice, the person of the clinician, and the clinician’s situation. (shrink)

Reflection has been proclaimed as a means to help physicians deal with medicine’s inherent complexity and remedy many of the shortcomings of medical education. Yet, there is little agreement on the nature of reflection nor on how it should be taught and practiced. Emerging neuroscientific concepts suggest that human thought processes are largely nonconscious, in part inaccessible to introspection. Our knowledge of the world is fraught with uncertainty, ignorance and indeterminacy, and influenced by emotion, biases and illusions, including the illusion (...) of not having illusions. Neuroscience also documents that lifelong learning processes may hone nonconscious cognition to high levels of sophistication, allowing rapid and precise perceptions, judgments and actions in complex situations. We argue that knowledge of mechanisms underlying human thought may be useful in designing educational programs to foster desired attributes such as curiosity, critical self-awareness and intuitive acumen in medical professionals. The juxtaposition of neuroscientific insights with ideas from Kant on reflective judgement, van Manen on tact, and Aristotle on phronésis, supports a concept of reflection that manifests as wise practice. We suggest that reflection in medical education should be an imperative for educators seeking to guide learners to manage the complexity and “messiness” of medical practice, and a role-modelling mode of medical practice characterized by self-correcting behaviors that culminate in good and right professional actions. An example illustrates reflective practice in the teaching and learning of physicianship. (shrink)

The clinical trial is the major investigational tool of clinical medicine. Two recent reports highlight the fact that the most often quoted mechanisms for the protection of research subjects, viz., research ethics board review and eligibility criteria, are insufficient to achieve this end. In this paper, we argue that the prime mechanism for the protection of persons in clinical trials should be the clinical judgement of the physician-investigator. The clinical investigator has a duty to protect subjects from both harm and (...) undue risk. It is argued that the clinical investigator has a duty to screen for, and exclude, potential research subjects who may be unduly vulnerable to the risks of a particular clinical trial. In order to fulfill this obligation, the investigator should personally screen each potential research subject at the time of accrual. In larger trials in which this is not feasible, this task could be delegated to another appropriately qualified health care professional, with the principal investigator retaining personal responsibility. To reinforce and make explicit this legal and moral duty, we propose that the investigator sign a statement, appended to each subject's consent form, to attest that this duty has been responsibly discharged. (shrink)

Maas's annotation on Fr. C, col. I in his edition of the new fragments says: ‘fortasse conferendi Diod. 13. 66. 6; Xen. Hell. 1. 3. 16–22; Dionys. Byz. Anapl. 13’. The comparison of Fr. C, col. I with the passage in Dionys. Byz. De Bospori Navigatione 13 seems to prove beyond reasonable doubt that the city referred to in the fragment is Byzantion. Consequently the supposition that the papyrus tells the story of the siege of Byzantion—dealt with in the other (...) two passages quoted by Maas—becomes almost a certainty. (shrink)

In thesis VI of Walter Benjamin’s On the Concept of History, we find the sentence of danger in which the dead are, which we can think of as a threat of a second death, or symbolic death of the oppressed tradition of which the historiographer has to be alert. Now, if there is a second death it is because there is a life after natural death, that is a survival [Nachleben] of the past in the present. This survival, in the (...) context of the theses of 1940, is possible to weave it with the notions of historical experience [Erfahrung] and the transmission thereof. Faced with the danger of the absolute disappearance of what has been truncated, the German author exposes the need to save it, that is, to carry out a redemption, a remembrance. In this sense, redemption would operate as a second chance, or second instance, of those who have already had a natural death, and who therefore survive, are in their "over-life", which is on the verge of disappearing. Redemption, in these terms, is reconfigured as a form of resistance, then, against the possible annihilation that would bury definitively those signifiers, those memories. Here we will essay thinking this possibles intersections between the benjaminians notions of survival, historic experience and redemption, and the lacanian notion of second death, for being able to think the duality of natural and simbolic death and life, the failed of natural death -the possibiliy of redemption that allows- and the absolut and irreversible character of second death. (shrink)

It is generally held that Plutarch's authority in his Vita Agidis was Phylarchos and that, consequently, our knowledge of Agis' programme derives solely from the Phylarchean, pro-Spartan, and generally unreliable tradition. There is little doubt that Plutarch's biography of Agis is based on Phylarchos. However, our knowledge of the programme of Agis does not depend solely on the Phylarchean tradition.

BackgroundPrevious empirical work among physicians has led us to propose that clinical practice is experienced by clinicians as an engagement-in-the-clinical-situation. In this study, we pursue our exploration of clinical practice ‘on its own terms’ by turning to the experience of patients.MethodsPhenomenological analysis of in-depth individual interviews with 8 patients.ResultsWe describe the patient experience as a set of three motifs: the shock on the realization of the illness, the chaos of the health care environment, and the anchor point provided by an (...) engaged physician. We draw on Heidegger’s notion of solicitude to show that patients are actively ascertaining the physician’s engagement in their care.ConclusionsThese findings lead us to question the classical “dual discourse” of medicine that offers a dichotomous account of clinical practice as the addition of care to cure, art to science, humanism to technique, and person to medical case. We found no such distinctions in our empirical investigation of clinical practice. Rather, in our synthesis, practice appears as a unitary experience. The physician’s solicitude for the patient entrains engagement in the clinical situation. Moreover, the solicitous, engaged physician constitutes an anchor point for the patient. (shrink)

The paper outlines a deflationary interpretation of Hegel’s metaphysics, as presented in the Encyclopedia of the Philosophical Sciences. It focuses mainly on the Science of Logic as a theory of categories, which explores the movement of the Concept. The major idea is to read Hegel’s identification of logic and metaphysics as a thesis on deflating metaphysics into logic and semantics. Hegel’s metaphysics, which may better be called logico-metaphysics, does not describe the objective world directly. Rather, as a second-order theory, it (...) unfolds and makes transparent the fundamental concepts that are necessary for our understanding of the world and our orientation in it. -/- The paper begins with a brief discussion of Hegel’s idea of philosophy as system. The argument is made that Hegel should be interpreted holistically, in contrast to the popular approach of distinguishing between what is living and what is dead in his philosophy. In the second and third parts of the paper, an analysis is given of Hegel’s criticism of Kant, with an explanation of how Hegel’s Logic further develops Kant’s project of transforming traditional metaphysics. Here, the interesting fact that Hegel’s logical categories are not derived from an absolute first principle is pointed out. Instead, the task of Hegel’s Logic is to comprehend and systematize the concepts that have already been evolved in the history of philosophy. In the last part of the paper, the deflationary approach is extended to Hegel’s Realphilosophie. While Hegel’s Logic takes the place of ontology, his Philosophy of Nature and Spirit offers a comprehensive metaphysica specialis, laying conceptual foundations for understanding various dimensions of reality, from nature through the ethical-political world to different cultural domains. The paper takes Hegel’s Philosophy of Objective Spirit as an example to illustrate how the deflationary interpretation sheds light on Hegel’s “practical” philosophy as a second-order theory that does not aim to uncover first-order normative principles for guiding actions, but rather to develop the concepts necessary for normative judgments. (shrink)

This paper develops a new functionalist interpretation of Kant that aims to unify his cognitive psychology with transcendental idealism. It argues that Kant’s faculty of cognition describes neither the phenomenal nor the noumenal mind, but a theoretical construct of the transcendental subject, comparable to the abstract Turing machine. This interpretation can be called “transcendental functionalism,” which determines what functions the mind has to realize if it is to be capable of objective cognition. Transcendental functionalism resolves problems associated with other functionalist (...) interpretations of Kant by drawing a systematic distinction between transcendental cognitive functions and their empirical realizations. While transcendental functions stipulate abstract conceptual requirements, their empirical counterparts realize the functional constraints in appearances within the spatiotemporal and causal framework. This distinction also allows a better explanation of why Kant abandoned the subjective deduction of categories in the B-deduction. (shrink)

This paper takes a fresh look at Kant’s transcendental idealism with a new reading of negative noumena as abstract entities. It shows that the three criteria for abstractness, i.e., non-spatiotemporality, causal inefficacy, and non-indiscernibility, are true of Kant’s negative noumena. Phenomena, by contrast, are concrete entities in space and time, which can be understood as spatiotemporally instantiated noumena. Kant’s distinction between noumena in the positive and negative sense will be reinterpreted as a distinction between non-spatiotemporally instantiated concrete entities and uninstantiated (...) abstract entities. It argues that noumenal ignorance is confined to positive noumena, which can be identified with things in themselves. (shrink)

This paper analyzes Kant’s epistemological reorientation of ontology, explaining in what sense Kant’s complex theory of transcendental idealism and empirical realism should be understood as an ontological realism under the framework of epistemological idealism. The paper shows that Kant’s concept of existence is only applicable to empirical objects in the spatiotemporal causal framework. Accordingly, not only things in themselves, but also epistemic conditions such as the transcendental subject and the faculties of sensibility and understanding cannot be said to exist. They (...) are theoretical constructs in the transcendental discourse to account for the normative conditions of objective cognition and reality. (shrink)

Hegel sees philosophy as the only rigorous science that does not have any presupposition, but he rejects the possibility of an absolute foundation for philosophy, instead maintaining that only the system as a whole can be free from all presuppositions. Hegel’s system lays claim to presuppositionlessness, not on the ground of any presuppositionless beginning, but rather as a holistic system of concepts in which inevitable presuppositions are made transparent and comprehended. This paper examines Hegel’s analysis of the concept of immediacy (...) and his critique of the foundationalist conception of philosophy. Although Hegel’s critique is targeted against his predecessors and contemporaries, it has important implications for Husserl’s phenomenology, which represents one of the most ambitious foundationalist projects in the history of philosophy. The final part discusses the later development of Husserl’s thought and his introduction of the concept of lifeworld in light of Hegel’s critique. (shrink)

This paper aims to make better sense of Hegel’s Philosophy of Objective Spirit and defend it against the charge of political conservatism and optimism. I will argue for the left Hegelian position in the theological-philosophical respect, thereby leaving the left-right divide in the social-political respect largely open. I will explain that Hegel’s commitment to the inherent rationality of the state and the course of human history as the progress of freedom does not imply blind optimism, since his thesis is not (...) to be taken as a factual description. Hegel’s point is rather a conceptual one: to comprehend the human world means to comprehend it as a holistically rational entity and process, which is the essential nature of comprehending in the context of the humanities. I will further clarify Hegel’s point by introducing relevant ideas from contemporary philosophy of mind and language, comparing it in particular with Davidson’s principle of charity. (shrink)

This paper analyzes and compares the doctrines of categories of Aristotle, Kant and Hegel, each of which is first discussed separately. The paper explains the essential double perspective of the problem, showing how a logico-linguistic analysis of the form of rational discourse serves for them as an important clue to ontological problems. Although Aristotle and Kant’s doctrines differ significantly, they both endorse a kind of isomorphism between language/thought and reality. By contrast, Hegel, who takes a critical attitude toward the capability (...) of human language and discursive thinking, rejects the possibility of deriving the structure of reality from the forms of predication or judgment. Nevertheless, the forms of judgment do play an equally crucial role in Hegel’s doctrine, though in a very different way from his predecessors. It is the structural “deficiency” of the judgmental form that turns out to be the driving force for the dialectical movement of the Concept. By shifting the primary concern from the categories themselves to the transitions between them, Hegel opens up the possibility of a dynamic system of categories. (shrink)

Even though the Cartesian mind-body dualism has largely been dismissed in contemporary philosophy, the idea that the conscious mind can be a bodiless and non-spatial entity is still held to be possible. This paper examines a series of arguments by Jaegwon Kim, Peter Strawson, and Immanuel Kant against the possibility of a disembodied mind. It is argued that although the concept of a disembodied mind is coherent, it derives from a more fundamental concept in which the mind and the body (...) are originally unified. The unity of mind and body, which can be called a person, is logically prior to the concept of the mind as a disembodied person, and thus the possibility of a disembodied mind turns out to depend on the existence of the physical and spatial world. (shrink)

The personhood of the physician is a crucial element in accomplishing the goals of medicine. We review claims made on behalf of the humanities in guiding professional identity formation. We explore the dichotomy that has evolved, since the Renaissance, between the humanities and the natural sciences. The result of this evolution is an historic misconstrual, preoccupying educators and diverting them from the moral development of physicians. We propose a curricular framework based on the recovery of Aristotelian concepts that bridge identity (...) and activity. The humanities and the natural sciences, jointly and severally, can fulfill developmental, characterological and instrumental purposes. (shrink)

The practice of medicine involves continual change, driven by a constant stream of developments in the understanding of biological structure and function relevant to human diseases, and the parallel improvements in pharmacologic and other technological interventions. This change is also driven by evolving social philosophies, ethical trends, and lifestyles. As products of society, doctors absorb contemporary values and norms. Indeed, it would appear that the ethical norms and standards of medical practice are flexible, and that the characteristics of medical practice (...) at any particular point in history may reflect the mores of the times rather than any enduring moral imperatives.However, a common perception .. (shrink)

The revelation that data obtained for the US-based National Surgical Adjuvant Breast and Bowel Project (NSABP) from subjects enrolled at Hôpital Saint-Luc in Montreal was falsified has eroded public trust in research. Institutions can educate researchers and help prevent unethical research practices by establishing procedures to monitor research involving human subjects. Research monitoring encompasses four categories of activity: annual reviews of continuing research, monitoring of informed consent, monitoring of adherence to approved protocols and monitoring of the integrity of data. The (...) authors describe characteristics of research projects that may call for monitoring procedures in each category. The form taken by such monitoring depends on the nature of the protocol. Although appropriate research monitoring requires substantial investment of personnel and financial resources, it is required under guidelines regulating research involving human subjects in Canada. Research monitoring is a step forward in re-establishing public confidence in medical research. (shrink)

Our study focuses on the perception of the iconicity of handshapes – one of the formational parameters of the sign in signed language. Seventy Hebrew speakers were asked to match handshapes to Hebrew translations of 45 signs, which are specified for one of the handshapes in Israeli Sign Language. The results show that participants reliably match handshapes to corresponding sign translations for highly iconic signs, but are less accurate for less iconic signs. This demonstrates that there is a notable degree (...) of iconicity in the lexicon of ISL, which is recognizable even to non-signers. The ability of non-signers to detect handshape to form is explained by the fact that word meanings are understood by both deaf and hearing peoples via the mental elaboration of simple iconic sources in which handshape meanings are grounded. The results suggest that while language external iconic mapping could ease the learning of direct iconic forms, it has a more limited capacity to help hearing non-signers learn indirect and opaque forms. The full semiotic distribution of handshapes in the lexicon and their use in language remain difficult for hearing non-signers to understand and depends on more specific language and cultural knowledge. (shrink)

The last stand of the Greeks against Rome before Greece sank into the limbo of the Roman Empire is to some a truly patriotic rising, to others a misguided attempt at the impossible. Whatever their general estimation, most scholars have recognised social traits in the Achaian War and in the events which immediately preceded it.To Kahrstedt it was ‘bolschewistisches Fahrwasser … Massenmord der Besitzenden und Gebildeten … Ausrottung der Bourgeoisie … eine reine Proletarierrepublik, ein Kampf gegen die eigenen Bourgeois und (...) gegen die kapitalistische italische Grossmacht’. Colin sees in the events of 147/6 B.C. traits of ‘une révolution sociale’. According to Fustel de Coulanges, ‘ils abolissent les dettes, ou tout au moins en diffèrent le payement. Ils affranchissent et arment les esclaves.’ To Oertel, it was ‘sozialistische Bewegung … die Ziele sind die alten’. According to Pöhlmann, ‘selbst in die letzte grosse politische Krisis der Nation … spielt die sozialdemokratische Bewegung mächtig hinein’. In the view of Benecke ‘the masses in the Greek cities were encouraged by promises of a social revolution, and the … Achaean general Critolaus did not dare to disappoint them’. According to Rostovtzeff, the aim of Rome in the destruction of Corinth was ‘to put an end to social and economic revolution’. Other authorities, such as Niese, Mommsen, De Sanctis, Tarn, Niccolini, note social traits in their accounts of the events of 147/6 B.C. without attempting a general view of the place of the social factor in the Achaian War. (shrink)

En las notas preparatorias de las tesis Sobre el concepto de historia [1940] (2009), Walter Benjamin señala que el materialista histórico debe, al recorrer la “estructura de la historia”, realizar un “análisis espectral” [Spektralanalyse]. Más allá de la familiaridad que Benjamin haya tenido con el método físico del análisis espectral, partimos de aquí para desprender un tema central, que es el de la epistemología de la imagen para un modelo de historia ya dialectizado con la naturaleza, en este caso, el (...) de Walter Benjamin y Aby Warburg. No solo es importante la noción de imagen e imagen dialéctica presente en los autores, sino también aquello que se contiene y transmite en la imagen, lo cual proviene de temporalidades pasadas. Por esto abordamos la idea de pervivencia [Nachleben] en ambos autores, y cómo esta se codifica, en el pensamiento de Waburg, en la idea de una vida energética y en las nociones de dinamograma, engrama y memoria. Lo que nos interesa de habilitar una mirada más amplia para con la historia, es exponer que la separación dicotómica entre historia y naturaleza -criticada tanto por Warburg como por Benjamin- inhabilita la posibilidad de captar un ámbito de lo objetual que es independiente del hombre, esto es, la energía o la fuerza que se contiene en el seno de una imagen, de allí lo interesante de tomar la mirada del físico para con la historia. (shrink)

ABSTRACT:The objective of this essay is to develop the argument that placebos are a species of metaphor and to demonstrate that an analysis of the figurative trope can help us elucidate the power of the placebo response. The cognitive and embodied responses to both metaphors and placebos stem from the transfer of meaning between two domains, each with rich allusive properties that in turn depend on highly ramified and interconnected neural webs. Metaphors and placebos require an appropriate cultural backdrop for (...) their linguistic and cognitive work and are dependent on shared social forms of life. More specifically, metaphors rely on an intersubjective connection and imply that a relational entanglement between doctor and patient is necessary to the effect of placebos in the clinical setting. (shrink)

Ocherk 1. Voprosy ontologii -- Ocherk 2. Voprosy ėtiki i ėstetiki -- Ocherk 3. Voprosy gnoseologii i aksiologii.

We studied changes in eligibility criteria--the largest impediment to patient accrual--in two samples of clinical trials. Trials from the NSABP (National Surgical Adjuvant Breast and Bowel Program) and POG (Pediatric Oncology Group) were analyzed. After eliminating duplications, the criteria in each protocol were enumerated and classified according to a novel schema. NSABP trials contained significantly more criteria than POG trials, and added precision criteria (making study populations homogeneous) at a faster rate than POG studies. The difference between NSABP studies (explanatory (...) trials) and POG studies (pragmatic trials) suggest that large numbers of eligibility criteria are not necessary for quality studies. We recommend that: (1) the inclusion/exclusion criteria distinction be abandoned; (2) eligibility criteria be explicitly justified; (3) the need for each criterion be assessed when new trials are planned; (4) criteria in phase III trials restricting patient accrual be minimized; and (5) further research be done to assess the impact of criteria on generalizability. (shrink)

OBJECTIVE: Pilot study to characterize treatment differences between patients treated in clinical trials and those treated in a clinical setting. Previous studies have shown higher survival rates for participants in trials of cancer therapy. This difference is observed even after rates are adjusted for important covariates such as age and stage of disease. DESIGN: Retrospective chart review. SETTING: Oncology outpatient department in a tertiary care hospital. PATIENTS: Ninety women 18 to 70 years of age with early-stage breast cancer who were (...) diagnosed in 1990. Fifty-one of the women were treated through clinical trials and 39 were treated outside of clinical trials. OUTCOME MEASURES: Number of blood tests, telephone calls, clinic visits and imaging procedures as well as intensity of chemotherapy and use of radiation therapy. The age of the patient and the stage of disease were important covariates. RESULTS: After the analysis was controlled for patient age and stage of disease, patients treated through a clinical trial were more likely to receive standard-dose chemotherapy (p = 0.020, 95% confidence interval 1.20 to 200.73) and more frequent blood tests (p < 0.001, 95% confidence interval 1.02 to 1.13) than other patients treated in the clinic. CONCLUSIONS: Our results provide a plausible mechanism for the observed survival advantage for participants in clinical trials in oncology. Further study is called for. If these results are confirmed, they have important implications for informed consent to participate in clinical trials and for clinical practice. (shrink)

Medical students gather lessons from what they observe and experience in the hospital and the clinic. The daily, generally undocumented events constitute significant formative influences on the developing identities of these nascent physicians. These experiences shape the students' attitudes towards their patients, help form their own identities, and affect their confidence in their chosen profession. And yet, these critical pedagogical forces rarely come to the attention of their teachers, who remain unaware of the powerful formative features of the clinical learning (...) environment. As a result, attending physician-teachers fail to... (shrink)

Na de Tweede Wereldoorlog heerstte in Duitsland nog lange tijd zwijgen over de misdaden van het Nazi-bewind. Pas in de Historikerstreit van 1985-1986 kwam het onverwerkte verleden in de openbaarheid.. Enerzijds werden de Duitse oorlogsmisdaden vergeleken met die van Stalin en Pol Pot, anderzijds werd de holocaust afgeschilderd als een soort natuurramp, die zich buiten de historische realiteit had afgespeeld. Over dit dilemma is het laatste woord nog niet gezegd.

The story of Dion of Syracuse was told by ancient writers, and is still being told by modern historians, in the main as a story of ‘freedom versus tyranny’. The liberation of the greatest state in the Hellenic world from the rule of the most powerful tyrants' house in Greek experience fired the imagination and aroused the admiration of contemporary and later writers. There is, however, another side to the story of Dion.

To what risks may children participating in research be subjected? Institutional review boards can stand surrogate for parents by filtering out studies whose risk is unacceptably high.

Kant insists that the use of concepts must be subject to empirical conditions if they are to have objective validity. This article analyses Kants distinction between empirical and transcendental truths. Since transcendental concepts are pure concepts without spatio-temporal content, their objective validity is of the same second-order kind as that of unschematized categories. This characteristic of transcendental concepts implies that the cognitive powers picked out by them are not particular psychological mechanisms, but rather abstract functional structures. Transcendental concepts owe their (...) objective validity to the realizability of the functional structures by empirical cognizers like humans. This relation in turn helps to explain the nature of transcendental truths. (shrink)

For Kant, both morality and the possibility of objective knowledge presuppose freedom. His theory of freedom is based on the distinction between phenomena and noumena, concepts which represent two different ways of viewing things. The question, however, is whether it is justified to take the noumenal perspective in addition to the phenomenal one. Isn’t freedom an illusion, if we regard ourselves as free, while in fact we are not? The crux of the problem lies in recognizing that there is no (...) objective fact as far as freedom is concerned, for objective fact is a category that belongs to the phenomenal world. Nevertheless, it is argued that freedom must be presupposed in order to account for the objectivity of the phenomenal world as a whole. (shrink)

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)