Towards an Empirically Informed Account of Phronesis in Medicine

Kotzee, Ben; Paton, Alexis; Conroy, Mervyn

doi:10.1353/pbm.2016.0029

Cited by 30 publications

(23 citation statements)

References 31 publications

(12 reference statements)

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“…Essential for one to endorse and demonstrate 'good' character is an ability to use well-informed judgement (e.g. Darnell et al 2019;Kotzee et al 2016;Seijts et al 2019). Aristotle refers to the overarching meta-virtue known as phronesis, or practical wisdom (Aristotle 2009), which serves as a moral integrator to critically evaluate and 'deliberate finely' about the relative weight of competing virtues (e.g.…”

Section: Character In the Professional Spherementioning

confidence: 99%

The Value of Character-Based Judgement in the Professional Domain

et al. 2019

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Dimensions of character are often overlooked in professional practice at the expense of the development of technical competence and operational efficiency. Drawing on philosophical accounts of virtue ethics and positive psychology, the present work attempts to elevate the role of 'good' character in the professional domain. A 'good' professional is ideally one that exemplifies dimensions of character informed by sound judgement. A total of 2340 professionals, from five discrete professions, were profiled based on their valuation of qualities pertaining to character and judgement. Profile differences were subsequently examined in the self-reported experience of professional purpose towards a wider societal 'good'. Analysis of covariance, controlling for stage of career, revealed that professionals valuing character reported higher professional purpose than those overweighting the importance of judgement or valuing neither character nor judgement, F(3, 2054) = 7.92, p < .001. No differences were found between the two groups valuing character, irrespective of whether judgement was valued simultaneously. This profiling analysis of entry-level and in-service professionals, based on their holistic character composition, paves the way for fresh philosophical discussion regarding what constitutes a 'good' professional and the interplay between character and judgement. The empirical findings may be of substantive value in helping to recognise how the dimensions of character and judgement may impact upon practitioners' professional purpose.

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Section: Character In the Professional Spherementioning

confidence: 99%

The Value of Character-Based Judgement in the Professional Domain

et al. 2019

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“…Practitioners note that the growing use of ever-closer codi cation/guidelines of good medical practice is not able to take into account the complexity of caring for patients with multiple comorbidities and within di cult contexts [27]. The culture of mere compliance to rules and guidelines [21,22] tends to oversimplify the complex clinical situation, making patients single-pathology entities rather than the multifaceted (medically and socially) humans they are.…”

Section: Discussionmentioning

confidence: 99%

“…Montgomery [16], Kaldjian [15] and Toon [17] offer book-length studies arguing that phronesis plays an important role in medical decision-making. Although there has been a drive to theorise about the importance of empirically-informed ethics [23][24][25], including phronesis [26], attempts to study clinical-judgement as phronesis using empirical data are rare [27]. Notable exceptions are Jordens and Little [28], Little et al [29], Jones et al [30] and Conroy et al [31].…”

Section: Introductionmentioning

confidence: 99%

Using practical wisdom to facilitate ethical decision-making: a major empirical study of phronesis in the decision narratives of doctors

Conroy

Malik

Hale

et al. 2020

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BackgroundMedical ethics has recently seen a drive away from multiple prescriptive approaches, where physicians are inundated with guidelines and principles, towards alternative, less deontological perspectives. This represents a clear call for theory building that does not produce more guidelines. Phronesis (practical wisdom) offers an alternative approach for ethical decision-making based on an application of accumulated wisdom gained through previous practice dilemmas and decisions experienced by practitioners. Phronesis, sometimes referred to as the ‘executive virtue’, offers a way to navigate the practice virtues for any given case to reach a final decision on the way forward. However, very limited empirical data exist to support the theory of phronesis -based medical decision-making, and what does exist tends to focus on individual practitioners rather than practice-based communities of physicians.MethodsThe primary research question was: What does it mean to medical practitioners to make ethically wise decisions for patients and their communities? A three-year ethnographic study explored the practical wisdom of doctors (n=131) and used their narratives to develop theoretical understanding of the concepts of ethical decision-making. Data collection included narrative interviews and observations with hospital doctors and General Practitioners at all stages in career progression. The analysis draws on neo-Aristotelian and MacIntyrean concepts of practice- based virtue ethics and was supported by an arts-based film production process.FindingsWe found that individually doctors conveyed many different practice virtues and those were consolidated into fifteen virtue continua that convey the participants’ collective practical wisdom, including the phronesis virtue. This study advances the existing theory on phronesis as a decision-making approach because only now a theoretical ‘collective practical wisdom’ exists. ConclusionGiven the arguments that doctors feel professionally and personally vulnerable in the context of ethical decision-making, our contribution in the form of a moral debating resource can support before, during and after decision-making reflection. The potential implications are that these theoretical findings can be used by educators and practitioners as a non-prescriptive alternative to improve ethical decision-making, thereby addressing the call in the literature, and benefit patients and their communities, as well.

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“…However, markers of safe, customised care and complex decision making can be overlooked or undermined as the prominent discourses within health services and medical training focus on defined systems and guidelines, areas that can be more easily measurable. The drive towards evidence‐based medicine may appear to be at odds with a more intuitive approach to decision making, stressing the role of tacit knowledge, clinical experience and professional judgement …”

Section: Introductionmentioning

confidence: 99%

Complex decision making in medical training: key internal and external influences in developing practical wisdom

2018

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Context Good judgement and the ability to make complex decisions are key attributes of a skilled professional. There has been limited study of doctors and their decision making, particularly in relation to making complex decisions. The study aims were to understand how trainee doctors develop practical wisdom through investigating their approach to difficult decision making, understanding the influences on the development of practical wisdom, and identifying potential interventions that may help develop this further. Methods Constructing an understanding of the process of developing practical wisdom was analysed within a social constructivist frame. The study investigated trainee doctors at different stages of their careers. Qualitative semi‐structured interviews were used to explore the approaches doctors take to difficult decision making, as well as the key training influences in learning these skills. Constant comparative analysis was carried out within a grounded theory approach. Results Key elements emerged from the data regarding the doctors themselves and the environments they worked in that assisted in developing decision making. This led to the construction of a conceptual model setting out the development of practical wisdom among trainee doctors. The model describes a process of gaining experience in decision making, moderated by key external and internal influences. The important roles of self‐efficacy and agency (relational) are highlighted as key enablers of the process. Discussion The implications of this model are considered in relation to postgraduate training of doctors. The importance of training doctors to be self‐regulated learners in learning environments that support their development is highlighted. Aspects of the clinical learning environment (structure) such as rotation structures, the culture, supervision and feedback can all be enhanced. Self‐efficacy and relational agency, alongside other internal influences, are key factors in accelerating development of practical wisdom. Other studies have shown that these factors can be improved with targeted interventions.

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Towards an Empirically Informed Account of Phronesis in Medicine

Cited by 30 publications

References 31 publications

The Value of Character-Based Judgement in the Professional Domain

The Value of Character-Based Judgement in the Professional Domain

Using practical wisdom to facilitate ethical decision-making: a major empirical study of phronesis in the decision narratives of doctors

Complex decision making in medical training: key internal and external influences in developing practical wisdom

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