Approaching diagnostic messiness through spiderweb strategies: Connecting epistemic practices in the clinic and the laboratory
Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
Standard
Approaching diagnostic messiness through spiderweb strategies : Connecting epistemic practices in the clinic and the laboratory. / Scott-Fordsmand, Helene; Tybjerg, Karin.
I: Studies in History and Philosophy of Science, Bind 102, 2023, s. 12-21.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
Harvard
APA
Vancouver
Author
Bibtex
}
RIS
TY - JOUR
T1 - Approaching diagnostic messiness through spiderweb strategies
T2 - Connecting epistemic practices in the clinic and the laboratory
AU - Scott-Fordsmand, Helene
AU - Tybjerg, Karin
N1 - Publisher Copyright: © 2023 The Author(s)
PY - 2023
Y1 - 2023
N2 - Scientific and medical practice both relate to and differ from each other, as do discussions of how to handle decisions under uncertainty in the laboratory and clinic respectively. While studies of science have pointed out that scientific practice is more complex and messier than dominant conceptions suggest, medical practice has looked to the rigour of scientific and statistical methods to address clinical uncertainty. In this article, we turn to epistemological studies of the laboratory to highlight how clinical practice already has strategies for dealing with messiness. We draw on Hans-Jörg Rheinberger's Toward a History of Epistemic Things, in which he invokes the metaphor of a spider's web to explain the role of tacit practices in experimental biochemistry for helping practitioners manage messiness. We argue that diagnostic practices in clinical medicine employ similar, albeit codified, procedures to evaluate epistemic significance, ensure sensitivity to the unforeseen, and allow focused grounds for action. We consider three practices: (a) the pre-set structure of medical records, ensuring broad coverage in initial anamnesis, (b) the use of lists of differential diagnoses and ongoing ‘anchoring and adjusting’ as inquiry progresses, and (c) shared decision-making as an occasion to synthesize empirical evidence and reopen inquiry for potential missed information. We end by suggesting that while philosophy of medicine may learn from laboratory epistemology, the sciences may learn something from medical practice.
AB - Scientific and medical practice both relate to and differ from each other, as do discussions of how to handle decisions under uncertainty in the laboratory and clinic respectively. While studies of science have pointed out that scientific practice is more complex and messier than dominant conceptions suggest, medical practice has looked to the rigour of scientific and statistical methods to address clinical uncertainty. In this article, we turn to epistemological studies of the laboratory to highlight how clinical practice already has strategies for dealing with messiness. We draw on Hans-Jörg Rheinberger's Toward a History of Epistemic Things, in which he invokes the metaphor of a spider's web to explain the role of tacit practices in experimental biochemistry for helping practitioners manage messiness. We argue that diagnostic practices in clinical medicine employ similar, albeit codified, procedures to evaluate epistemic significance, ensure sensitivity to the unforeseen, and allow focused grounds for action. We consider three practices: (a) the pre-set structure of medical records, ensuring broad coverage in initial anamnesis, (b) the use of lists of differential diagnoses and ongoing ‘anchoring and adjusting’ as inquiry progresses, and (c) shared decision-making as an occasion to synthesize empirical evidence and reopen inquiry for potential missed information. We end by suggesting that while philosophy of medicine may learn from laboratory epistemology, the sciences may learn something from medical practice.
KW - Clinical medicine
KW - Diagnosis
KW - Messiness
KW - Rheinberger
KW - Tacit knowledge
U2 - 10.1016/j.shpsa.2023.08.006
DO - 10.1016/j.shpsa.2023.08.006
M3 - Journal article
C2 - 37722179
AN - SCOPUS:85171778509
VL - 102
SP - 12
EP - 21
JO - Studies in History and Philosophy of Science Part A
JF - Studies in History and Philosophy of Science Part A
SN - 0039-3681
ER -
ID: 369084699