Enacted Phronesis (Practical Wisdom) in Medical Practitioners: An Empirical Mixed Methods Study

Abstract

Background Phronesis (Practical Wisdom) is a useful way of conceptualising professional knowledge in the field of Medicine. Phronesis is one of five intellectual virtues described by Aristotle. Two of these intellectual virtues are well embedded in Medical Education; scientific knowledge (episteme) and technical skill (techne). The remaining two intellectual virtues are philosophical wisdom (sophia) and intellectual insight (nous). A critical interpretive literature review identified a lack of empirical work on the characteristics of phronemoi (wisdom exemplars). This paper is based on mixed-method PhD research which sought to determine the constituents of enacted phronesis in a population of family medicine practitioners in the UK. The work is positioned in a constructivist paradigm.Methods A validated wisdom questionnaire (Ardelt 3D wisdom scale) was administered to 211 General Practitioners (GPs) at five training events. Outlier scoring doctors were invited to participate in biographic narrative interviews. 18 doctors were interviewed, 16 of which met Ardelt’s criterion for high levels of wisdom. Individual transcripts were analysed using the Wengraf biographic narrative interpretive method (BNIM), this looked at the lived life and told story of the exemplar and resulted in the generation of vignette statements which have been used for teaching. All transcripts were analysed using corpus linguistic frequency analysis, this enabled a conceptual framework to be produced which facilitated comparison of narratives and reflected the expressed thought-processes of the exemplars.Results 34 constituents of enacted phronesis were identified in 5 key areas: their personal qualities, contexts, mental habits, knowledge-of-self and relational aspects. The 34 constituents inform practical action through wise deliberation. Comfort in dealing with uncertainty differentiated the wisdom exemplars from lower scoring participants.Conclusions This work has made explicit what is ordinarily tacit in relation to the process of phronesis. It has the potential to impact undergraduate medical education, continuing professional development and educational policy. The work also relates the concept of phronesis to flourishing (eudaimonia), and demonstrates that wiser doctors are happier doctors.

Practical wisdom in medicine through the eyes of medical students and physicians

“…This dependence is illustrated, for instance, when it is suggested that those who demonstrate practical wisdom need to be just so they can see the proper claims of others, temperate so that their vision is not clouded by the pleasures or distractions of the moment, and courageous so that they will persist in what they see as good even when it does not work to their personal benefit 60 . Such observations conform with empirical evidence that associates multiple virtues with wise decision making in medicine 30,61 and with claims about the way good professional judgement in medicine depends on additional traits, such as the courage, diligence and curiosity needed to navigate ambiguous and uncertain situations 62 . More generally, our results confirm what typical lists of virtues relevant to medicine imply, that practical wisdom is one of many character traits physicians need to excel as health professionals 3,51,56,63–66 .…”