Tacit clues and the science of clinical judgement [a commentary on Henryet al.]

Virtue, progress and practice

“…One distinguishing feature of this work is that analysts must be prepared not only to describe but to 'criticize' the responses of participants if the study is to be of philosophical value, while in other types of empirical study, the idea of criticizing or objecting to 'the data' has no legitimate role and indeed makes very little sense. The paper comments primarily on Duncan and Stephenson [47] but also offers an appraisal of the other papers in this section [41][42][43][44][45][46] and raises fundamental methodological questions about the still embryonic discipline of 'empirically informed philosophy'.…”

“…Hillel Braude welcomes what he regards as a timely and relatively novel contribution to a challenging task, that of providing a concrete evaluation of tacit knowing in the doctor–patient encounter. This task involves translating ‘the unspecifiable in clinical practice’ into rational terms, thus distinguishing tacit clues from ‘what may otherwise be deemed magical or mystical’[42]. Phil Hutchinson and Rupert Read take a more sceptical view [43].…”

“…In 2010, the journal presented its first ever philosophy thematic edition, including papers by some of the most original and incisive thinkers the discipline has to offer on a vast range of subjects of urgent practical import [11]. This, the second thematic edition of the Journal of Evaluation in Clinical Practice to focus specifically on the application of philosophical methods and argumentation to medicine and health care, provides an even greater range of papers [25–60] on the themes of progress in medicine, virtue in practice, and evidence and methodology in research and evaluation. Articles bring fresh and challenging analyses of the relationship between progress in the science and the practice of medicine, the role and limitations of statistical reasoning in medical research, patient involvement, autonomy and rationality, the relationship between reason and emotional engagement in the life of the good practitioner, the role and value of uncertainty in health care and how to promote virtue in practice.…”

Criticizing the data: some concerns about empirical approaches to ethics

“…I have sympathies with both the more positive and the more sceptical commentaries on their work [26,27]. There is an element of circularity to their approach [27] but not necessarily vicious circularity, as they are trying to show how an approach based on tacit knowledge can provide the basis for a plausible reading of practitioner and patient understandings [26]. So, they posit a conceptual framework and then try to show that a coherent description of the data is possible given that framework.…”

Explanation, understanding, objectivity and experience

“…It is also commonly -but again not universally -accepted that we lack a full understanding of the problems we seek to treat if we do not have a proper account of the human, subjective experiences that (arguably) prompt us to conceptualize a given condition as a 'problem' in the first place [15][16][17][18][19][20]. Some critics maintain that the modern emphasis on biomedical science, its undoubted initial benefits notwithstanding, has led in recent times to a neglect of the lived experience of health and illness, and to the rise of a theoretically motivated reductionism that threatens to impoverish practice [21][22][23][24][25][26].…”