Medical heuristics and action-research: professionalism versus science

Abstract

Background Professional knowledge aims at improving practice. It reduces uncertainty in decision-making, improves effectiveness in action and relevance in evaluation, stimulates reflexivity, and subjects practice to ethical standards. Heuristics is an approach to problem-solving, learning, and discovery employing a practical methodology that, although not optimal, is sufficient for achieving immediate goals. This article identifies the desirable, heuristic particularities of research in professional, medical practice; and it identifies what distinguishes this research from scientific research. Main text We examine the limits of biomedical and sociological research to produce professional knowledge. Then, we derive the heuristic characteristics of professional research from a meta-analysis of two action-research projects aimed at securing access to essential generic drugs in Senegal and improving physicians’ self-assessment and healthcare coordination in Belgium. To study healthcare, biomedical sciences ignore how clinical decisions are implemented. Decisions are built into an articulated knowledge system, such as (clinical) epidemiology, where those studied are standardisable - while taking care of patients is an idiosyncratic, value-based, person-to-person process that largely eludes probabilistic methodologies. Social sciences also reach their limits here because descriptive, interpretative methods cannot help with gesture and speech quality, while the management of the patient’s suffering and risks makes each of them unique. Research into medical professionalism is normative as it is intended to formulate recommendations. Scientific data and descriptions are useful to the practitioner randomly, only from the similarities in the environment of the authors and their readers. Such recommendations can be conceived of as strategies, i.e., multi-resource and multi-stage action models to improve clinical and public health practice. Action learning and action-research are needed to design and implement these strategies, because their complexity implies trial and error. To validate a strategy, repeated experiences are needed. Its reproducibility assumes the description of the context. To participate in medical action-research, the investigator needs professional proficiency - a frequent difficulty in academic settings. Conclusion Some criteria to assess the relevance of publicly funded clinical and public health research can be derived from the difference between scientific and professional knowledge, i.e. the knowledge gained with real-life experience in the field.

Follow-Up of a Cohort of Patients with Post-Acute COVID-19 Syndrome in a Belgian Family Practice

“…It is the doctor's ability to listen to the patient, to be surprised and to think about a new situation that will be central to the process of uncovering the new condition. At the same time, the doctor's experience is profoundly transformed by the research since he is an actor in it [67]. Consequently, the quality of the observations changed between the first and the fifty-fifth patient in the presented study.…”

“…This evidence is under construction as patients and doctors work together to develop knowledge. It is a type of action research [67] by which, as J. Pols points out, it is up to us to articulate the knowledge that patients develop [68].…”

Descriptive and Narrative Study of Long Covid Cases in General Practice and Diagnostic Value of Single Photon Emission Computed Tomography (SPECT scan)

“…These three pillars are also the pillars of Evidence Based Medicine. 48 But in this case, a. Family doctor and general practitioner are equivalent.…”

“…These three pillars are also the pillars of Evidence Based Medicine. 48 But in this case, there is no evidence yet, it is under construction as patients and doctors work together to develop knowledge. It is therefore a type of action research 49 by which, as J. Pols points out, it is up to us to articulate the knowledge that patients develop .…”