Conciliating cognition and consciousness: the perceptual foundations of clinical reasoning

Abstract

Clinical reasoning has been defined as a form of cognition applied to evaluating and managing a patient's medical problem. As a kind of cognition, a product of the human psyche, it is logical to expect that clinical reasoning should be best understood through methods derived from psychology, neuropsychology and the cognitive sciences. However, the application of scientific methods to evaluating clinical reasoning is unable to analyse clinical reasoning in terms of first-person experience and consciousness. By reducing clinical reasoning to its cognitive components the cognitivist approach tends to ignore the larger context in which clinical reasoning occurs. By reducing its conception of clinical reasoning to its cognitive components, the neuropsychological approach fails to acknowledge clinical reasoning as a form of intentionality, a gestalt, grounded in human perception. A full epistemology of clinical reasoning requires a phenomenological analysis that can make sense of the relation between pre-reflective consciousness and explicit forms of knowing. In this paper I conciliate cognition and consciousness in medicine through analysing the phenomenology of perception in clinical reasoning. I compare the application of phenomenology to clinical reasoning with the attempt to model clinical reasoning on Aristotelian practical wisdom or phronesis. Finally, I analyse empathy as a type of perception critical for effective clinical interaction and exemplary for reflecting on perception as the intersubjective foundation of clinical reasoning.

Investigating Philosophies Underpinning Dietetic Private Practice

“…A successful therapeutic relationship requires the practitioner to build a good rapport, show empathy, and gain the trust of their client [39]. Braude states that within the intersubjective space between the practitioner and patient, elements exist that are beyond the cognitions of the practitioner and patient [20]. Despite being beyond cognition, these nonverbal, tacit clues that exist within the context of the therapeutic relationship, provide valuable information to the practitioner, which they draw upon to appropriately respond to their patient [20].…”

“…Braude suggests that perception connects cognition and consciousness, and that it is important for clinical reasoning [20]. He suggests that these perceptions are present within the therapeutic relationship and contends that, when perception and intuition are combined with the explicit, phronesis is a fitting concept to apply to clinical decisions [20]. Phronesis, then, underpins the practice of using tacit clues which are implicit within the consultation process, to assist in being responsive to the patients’ needs.…”

“…Proponents within medicine and nursing have noted gaps in research where EBP has failed to address important areas of practice that exist on the human level, in consultation with the patient [18,19,20,21]. They have proposed a practice framework which incorporates three philosophies that arguably underpin the skillsets and behaviors of practitioners whom are able to practice in a holistic way, working to address the particular needs of the patient [18,19,20,21,22,23,24].…”

“…They have proposed a practice framework which incorporates three philosophies that arguably underpin the skillsets and behaviors of practitioners whom are able to practice in a holistic way, working to address the particular needs of the patient [18,19,20,21,22,23,24]. These philosophies encompass reflective practice and clinical judgement, as well as skills that are not easily identifiable in a quantitative way [18,22,24,25].…”

Reason and value: making reasoning fit for practice

“…Calder notes that their findings are unlikely to surprise anyone who has thought seriously about the difficulties in designing and delivering professional ethics courses that help to develop the skills of practical reasoning . The findings of the empirical study certainly gel with the concerns of other contributors to this volume about the need to find ways to develop the epistemic and ethical virtues to support wise practice, and Calder notes the difficulties in cultivating such essential character traits as ‘resilience’. Certainly similar studies in other contexts are warranted.…”