The Powers of a Fish: Clinical Thinking, Humanistic Thinking, and Different Ways of Knowing

How are ways of knowing similar between clinical reasoning and the humanities, and can the latter be used to elucidate the former? This commentary considers a conceptual model proposed by Prince and colleagues in this issue to explore the different ways of knowing in art and medicine. Their proposed model links 2 approaches to clinical reasoning with an analytic approach said to be characteristic of the humanities-visual thinking strategies (VTS)-to teach skills in clinical reasoning. They suggest that the VTS approach aligns well with the 2 clinical reasoning approaches and use this relationship to argue for the introduction of the humanities into graduate medical education. However, is VTS truly an exemplar of analytic approaches used in the humanities? The approach to clinical decision making is a version of what Donald A. Schön calls technical rationality, but what is the epistemology used in the humanities and art? This commentary explores this question through the perspective of hermeneutics, a branch of philosophy that centers on an interpretive understanding of art, and through art, a way of knowing the self, others, and the world. In contrast to limiting the focus of the humanities in medical education to sharpening the powers of observation and analytical thinking, the author argues that art also offers a way to explore the challenges and triumphs of providing care to those in need and to explore the meanings, feelings, and experiences of living and dying. It offers a way of understanding and expressing the moral dilemmas of our time that aspires toward the aesthetic, philosophical, and existential truths of a life in medicine.