A novel clinical framework: The use of dispositions in clinical practice. A person centred approach

Abstract

This paper explores a novel clinical framework that is underpinned by a specific philosophical perspective of causation and its utility in clinical practice. A dispositional theory of causation may overcome challenges that clinicians face in complex clinical presentations including those that are medically unexplained. Dispositionalism identifies causes not as regular events necessitating an effect but rather phenomena, which are highly complex, context‐sensitive, and which tend toward an effect. Diagnostic uncertainty and causal explanation are significant challenges in terms of clinical reasoning, communication, and the overall therapeutic outcome. This novel framework aims to facilitate improved collaborative clinical reasoning, enhanced patient‐practitioner interaction, and supported treatment planning. The paper uses a real case study of a patient with nonspecific spinal pain to demonstrate the clinical framework as used in clinical practice.

Reasoning, evidence, and clinical decision‐making: The great debate moves forward

“…Matthew Low explores the potential of a dispositional metaphysics, paired with a vector model of causation, for improving person‐centred clinical reasoning . Low argues that this understanding of causation is well suited to clinical encounters involving complexity and medically unexplained symptoms, particularly by virtue of accounting for the context‐sensitivity of medical causation and the particularities of the individual patient.…”

“…Just as many authors in our collection emphasize the social nature of knowledge and the centrality of context to practical reasoning, so many challenge, implicitly or explicitly, other modern dichotomies. The strict dichotomy between evidence and value—the former concerned with objective fact and the latter invariably reduced to matters of subjective “preference”—suggests a clear philosophical dividing line between epistemic questions (concerning knowledge, empirical data, and reason) and questions of an evaluative or moral nature (concerning what should be the case, what is preferable, matters of emotion and personal commitment).…”

“…In this edition, we present an array of up‐to‐date analyses of the problems of reason in practice, addressing a diverse range of healthcare contexts and methods, considering policy decisions as well as specific instances of clinical reasoning . Contributors discuss the nature of practical wisdom, the relationship between reasoning, emotion, intuition, and evidence, and the sense in which EBM is (or is not) a “modern” scientific enterprise, in the light of considerations of the relationship between science, context, and culture .…”

“…The edition includes important sections on mental health, where questions ranging from epistemic injustice to psychiatric nosology and validity are analysed—discussions given both specificity and depth via a range of papers from a significant conference on how we conceptualize a number of psychiatric disorders . There is also a significant section on causal reasoning, publishing papers delivered to a recent gathering of the CauseHealth collaboration . The growing interest in medical and health philosophy is illustrated by the number of important texts currently being published in this area, and we present reviews of some of the most recent work in this field .…”

“…[23][24][25][26][27][28] There is also a significant section on causal reasoning, publishing papers delivered to a recent gathering of the CauseHealth collaboration. [29][30][31][32][33][34][35] The growing interest in medical and health philosophy is illustrated by the number of important texts currently being published in this area, and we present reviews of some of the most recent work in this field. [36][37][38][39][40][41][42] The edition concludes with an extensive debates section, where arguments presented in this and in previous editions are challenged by respondents, [43][44][45][46][47][48][49][50][51] in ways that we hope will further illustrate how underlying philosophical commitments can make a substantive difference to our understanding of the right ways to approach and improve practice.…”