Clinical Science and Clinical Expertise: Changing Boundaries between Art and Science in Medicine

Gordon, Deborah R.

doi:10.1007/978-94-009-2725-4_11

Cited by 45 publications

(33 citation statements)

References 62 publications

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“…This diversion of blame away from individuals and institutions may reflect difficulties with dealing with not knowing, and the primacy of the 'art' of medicine. The challenge of integrating new technologies and probabilistic-oriented guidelines into medicine is long standing and well described in Europe and the USA, where such 'evidence' has been doubted, reinterpreted, used as a starting point, added as one part of a tool-kit, or cast out in favour of other better established knowledges (Gordon, 1988;Kassirer, 1992;Tanenbaum, 1994). The introduction of parasite-based guidelines and equipment represents the same challenge, instigated by the evidence-based movement in the North, but expected to be played out far more rapidly in the South.…”

Section: Enacting Malaria: 'Evidence'mentioning

confidence: 99%

‘As a clinician, you are not managing lab results, you are managing the patient’: How the enactment of malaria at health facilities in Cameroon compares with new WHO guidelines for the use of malaria tests

Chandler

Mangham

Abanda

et al. 2012

Social Science & Medicine

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Section: Enacting Malaria: 'Evidence'mentioning

confidence: 99%

‘As a clinician, you are not managing lab results, you are managing the patient’: How the enactment of malaria at health facilities in Cameroon compares with new WHO guidelines for the use of malaria tests

Chandler

Mangham

Abanda

et al. 2012

Social Science & Medicine

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“…Interestingly, North American medicine is described as featuring much more separation between conventional biomedicine and other practices as compared to European countries. Finally, despite many attempts to promote evidence-based practice among physicians (Gordon, 1988b), studies have shown that the results of controlled clinical trials typically fail to influence practice (Chalmers, 1974;Bunker et al, 1978), and that the published literature seems to have little influence on physician practice (Banta, 1984). These examples, and others, have served to cast doubt on the claims of biomedicine to be purely evidence-based.…”

Section: The Alternative Perspectivementioning

confidence: 92%

Four perspectives on unconventional therapies

Gray

1998

Health (London)

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In recent decades, North American health consumers have increasingly turned to unconventional therapies to complement, or replace, traditional biomedical practices. The topic of unconventional therapies can no longer be ignored or marginalized because, for better or worse, each seriously ill person cannot help but be confronted with choices about their possible usage. In this paper four perspectives relevant to a consideration of unconventional therapies are characterized and discussed, with cancer used to exemplify issues. The perspectives include the biomedical, the alternative, the progressive, and the postmodern. Each perspective is discussed in terms of its implications for patient choice. All perspectives are potentially helpful, dependent upon individual factors and the stage of illness, and patients tend to modify their perspective to meet circumstances. However, the postmodern perspective is argued to most clearly allow for the changing needs of ill persons, and the many inherent uncertainties involved with serious illness. KEYWORDS alternative; biomedicine; postmodernism; unconventional ACKNOWLEDGEMENT I wish to thank Kathryn Church, Alastair Cunningham, and Brian Doan for their exceedingly helpful comments on earlier drafts of this paper.

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“…The overall consequence of our scientism is that in our era, science, particularly in its quantitative, probabilistic, empiricist form, is conceived as the only legitimate form of rationality (Gordon 1988a). Thus physicians and social scientists strive to act and think by referring to scientific standards-indeed by turning to an idealized vision of science rather than science as it is practiced (MacIntyre 1979:90;McMullin 1979: 173-75;Polanyi 1958).…”

Section: Delegitimation and Dismissal Of Humanismmentioning

confidence: 98%

“…Standing against these efforts, however, is the scientism of health services research, particularly in its reliance on clinical outcomes research (Brook 1989) and clinical epidemiology (Wennberg 1984). Rather than instill an ethic and practice that clinical medicine focus on the meaning of illness for a life-a cultural phenomenon-this form of positivism strengthens the tendency to abjure meaning in favor of a disease's cause, course, and effect on the body, and the abstracted probability of its occurrence (Gifford 1986;Gordon 1988a;Tanenbaum 1993). Rather than encourage doctors to understand the fullness of the patient's situation, these efforts reinforce biomedicine's tendency to abstract from that context by subjecting doctors to the purported "regularities" that govern illness and health practices.…”

Section: Frankford Scientism and Econornisrn 791mentioning

confidence: 99%

Scientism and Economism in the Regulation of Health Care

Frankford

1994

Journal of Health Politics, Policy and Law

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As health care costs continue their apparently relentless rise, it seems to be universally perceived that the United States and western Europe are gripped by a cost crisis. To resolve the apparent crisis, U.S. and western European governments and third-party payers are turning increasingly to a new positivist discipline, called health services research, for which neoclassical health economics is the dominant discourse. However this discipline may actually reinforce the strength of biomedical positivism and the concomitant technological imperative. Like biomedicine, health services research is technologically driven, dependent on "advances" that generate more comprehensive and therefore more "accurate" data. Accordingly, just as biomedicine causes health care workers and patients to depend on technologies for diagnosis and treatment, health services research instills in the body politic dependence on technocratically conceived solutions for political problems. Moreover, because biomedicine and health services research share positivist epistemic and methodological premises, both objectify the subjects they study, abstract those subjects from context, and thereby ignore the cultural dimensions of the problems at hand. Rather than inculcate an ethic and practice in which medicine focuses on the meaning of illness for a life, a cultural phenomenon, this form of positivism strengthens the tendency to reject meaning in favor of the causes and course of disease and the abstracted probability of its occurrence. Accordingly health services research and the forms of regulation with which it is allied threaten to overwhelm the medical humanities movement. Furthermore this scientism precludes the institutionalization of political forums in which we can deliberate on the meaning of medicine, health, and death in our lives.

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Clinical Science and Clinical Expertise: Changing Boundaries between Art and Science in Medicine

Cited by 45 publications

References 62 publications

‘As a clinician, you are not managing lab results, you are managing the patient’: How the enactment of malaria at health facilities in Cameroon compares with new WHO guidelines for the use of malaria tests

‘As a clinician, you are not managing lab results, you are managing the patient’: How the enactment of malaria at health facilities in Cameroon compares with new WHO guidelines for the use of malaria tests

Four perspectives on unconventional therapies

Scientism and Economism in the Regulation of Health Care

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