Abstract:Rationale, aims, and objectives: In recent publications, attention has been drawn to the importance of practical wisdom in order to ensure good, individually attuned care in complex clinical practices. However, what remains insufficiently elucidated is how practical wisdom emerges in the workplace. This study aims to describe manifestations of practical wisdom in medical practices within a general hospital. It also seeks to clarify the interruptions that can be considered as triggers for the emergence of pract… Show more
“…Bontemps‐Hommen et al contribution tackles the wicked problem of acting wisely in the interest of the patient with multiple intertwined diseases and do so in a working environment consisting of complex networks of coacting professionals and other immaterial agents .The patient cases selected are all characterized by complexity, ie, the patients suffer from multiple, intertwined physical diseases; they may have psychological and social problems as well; moreover, the treatment situations, in which different disciplines have to work together intensively, are complex. Furthermore, it was possible only in very few of these cases to make a prima vista diagnosis, nor was a straightforward treatment strategy according to a protocol or guideline generally possible.…”
Section: The Key To Understanding Complexity Is An Awareness Of Complmentioning
“…Bontemps‐Hommen et al contribution tackles the wicked problem of acting wisely in the interest of the patient with multiple intertwined diseases and do so in a working environment consisting of complex networks of coacting professionals and other immaterial agents .The patient cases selected are all characterized by complexity, ie, the patients suffer from multiple, intertwined physical diseases; they may have psychological and social problems as well; moreover, the treatment situations, in which different disciplines have to work together intensively, are complex. Furthermore, it was possible only in very few of these cases to make a prima vista diagnosis, nor was a straightforward treatment strategy according to a protocol or guideline generally possible.…”
Section: The Key To Understanding Complexity Is An Awareness Of Complmentioning
“…[16][17][18][19][20][21][22] The ideas are being revived and applied to current issues in the social sciences and professional practices, including health care. [23][24][25][26][27][28][30][31][32][33] Consequently, it is worth keeping Aristotle's categories and the original language in mind because they are much more precise than the English terms which often are confused or taken to mean the same thing but do not, as happens in casual, daily use and over the course of time due to theoretical-cultural shifts. Additionally, for all their value, many current uses of "phron esis" remain inadequate, even misleading, interpretations.…”
Section: Retrieving the Classical Traditionmentioning
confidence: 99%
“…87,cf88 At the opposite end of the scale, individuals (and even societies of individuals) are statistically dissolved into populations-one of the major differences, for example, between public health approaches and those of primary care doctors, nurses, and therapists. 26 Unavoidably, the alternative views entail ethical implications as to who-or what-we are treating, what we may or may not do, when pursuing health and well-being.…”
Section: Legitimate Possibilities For Judgement In Ethics Pedagogy Management Policymentioning
Parts 1 and 2 in this series of three articles have shown that and how strong evidence-based medicine has neither a coherent theoretical foundation nor creditable application to clinical practice. Because of its core commitment to the discredited positivist tradition it holds both a false concept of scientific knowledge and misunderstandings concerning clinical decision-making. Strong EBM continues attempts to use flawed adjustments to recover from the unsalvageable base view. Paper three argues that a promising solution is at hand if we can manage several modes of inclusion. A modified original, moderate version of EBM continues though usually overshadowed. As definitively laid out by Sackett in the 1990s, clinical decision making is intended to be person-centered, recognizing and integrating multiple modes of evidence and knowledge that have been marginalized: professional experience, illness narratives, and individual patients' values and preferences. Complementary resources are at hand: interpretative understanding and practice, such as philosophical anthropology, hermeneutical phenomenology, complexity theory, and phronetic practices respond to the major problems and open new possibilities. Phronesis is especially important in regard to public decision making. Within part 3 an additional tone necessarily occurs. While most of papers 1, 2, and 3 are written in the classical mode of contrasting the theoretical-logical and empirical evidence offered by contending positions bearing on the decision making and judgement in clinical practice, a shift occurs when considerations move beyond what is possible for clinical practitioners to accomplish. A different, discontinuous level of power operates in the trans-personal realm of instrumental policy, insurance, and hospital management practices. In this social-economic-political-ethical realm what happens in clinical practice today increasingly becomes a matter of what is "done unto" clinical practitioners, of what hampers their professional action and thus care of individual patients and clients.
“…La práctica basada-en-la-evidencia no deja de tener aspectos cientificistas en tanto pretende suplir la evidencia basada-en-la-practica, el sentido común, los conocimientos locales, así como la prudencia o frónesis, fundamentales en la práctica clínica que se precie. De hecho, la frónesis o prudencia se reivindican hoy en medicina (Bontemps-Hommen et al, 2019;Saiz Fernández, 2018). Ante pandemias siguen vigentes medidas medievales como el aislamiento.…”
Section: Mala Ciencia Cientificismo Integracionismounclassified
omo la noción de embrollo inspirado por el uso que le da Gustavo Bueno en sus lecciones de 2013 sobre El reino del hombre y el hombre histórico referido a una acumulación confusa de cosas que por separado parecen claras. Bueno recupera el término antes usado por Benito Feijóo (1676-1764), el mismo que da nombre a la plaza
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