Clinical judgement, expertise and skilled coping.

Area of Science:

• Medical Philosophy
• Clinical Expertise Studies

Background:

• Medicine requires both practical, situation-specific skills and general knowledge.
• Existing models often favor 'technical rationality' (evidence-based medicine), neglecting practical expertise.
• The relationship between general knowledge and situation-specific skills in clinical judgment is debated.

Purpose of the Study:

• To examine the nature of expertise in medicine.
• To evaluate philosophical models of clinical judgment, particularly Hubert Dreyfus's account.
• To propose a unified model of clinical judgment that integrates practical and conceptual elements.

Main Methods:

• Analysis of a published account of skills in anaesthesia.
• Critique of Hubert Dreyfus's philosophical arguments on expertise.
• Development of a conceptual framework for clinical judgment.

Main Results:

• Dreyfus's model, while highlighting the dependence of general knowledge on situation-specific skills, incorrectly assumes these skills are 'mindless'.
• Criticism of Dreyfus's arguments reveals the conceptual structure inherent in practical expertise.
• A unified account of clinical judgment is proposed, reconciling practical skills with conceptual justification.

Conclusions:

• Clinical judgment is both practical and conceptually structured.
• A balanced approach is needed, valuing practical expertise alongside technical rationality.
• This work offers a framework for understanding medical expertise more holistically.