The Thought Style of Physicians

Abstract

The differential selection and assessment of knowledge is a key feature of medical practice. This paper presents a study of how doctors select and assess information in practice. Fourteen internal medicine professors from a relevant medical school in Rio de Janeiro, Brazil, were selected through preliminary interviews with medical students. The professors were subjected to open-ended interviews. The resulting material was interpreted through a conceptual framework derived from Ludwik Fleck, in order to establish the relevant elements of the thought style characteristic of the way they select and acquire new knowledge. The thought style that emerged from this set of interviews can be briefly characterized as a largely intuitive, pragmatic, result-oriented search of relevant (that is, potentially useful in practice) information. The doctors sought sources with academic credibility, but they maintained primary interest in practical, experiential knowledge. They also expressed a rather sceptical stance, at times bordering on cynicism. Despite this mistrust, doctors lack the resources (time, knowledge of technical aspects of research, particularly in terms of epidemiology and statistics) to effectively assess knowledge that is constantly being force-fed to them. This relative lack of resources is worsened, on one side, by the perception of medicine as subject to frequent and major changes, and on the other by the vastly disproportionate forces available to those who effectively produce and distribute such knowledge.

Epistemic cognition in medical education: a literature review

“…Lingard et al inferred that medical students’ conceptions of credible sources of information are influenced by implicit messages that patient accounts are unreliable, thus preserving physicians’ authority 33 . Approaches used to teach evidence-based medicine, de Camargo argues, often fail "to acknowledge the extensive social, economic and even political roots of the dilemmas faced by doctors” 48 . This is consistent with other authors who have argued that the prominent discourse of evidence-based medicine prioritizes knowledge from experimental research over experiential knowledge; the concept of knowledge translation overshadows views of medical knowledge as socially-negotiated, value-laden, or built from experience 50 , 51 …”

“…Among these are integrating first-hand patient experience early in the curriculum to encourage understanding and management of uncertainty, 21 , 32 incorporating, problem-based learning to enhance relativistic epistemology, 26 and providing students with tools and resources for judging and interpreting medical information 48 . Additionally,  Stolper et al argue that tacit “gut feelings” should deliberately be explored in the curriculum as ways of knowing 22 …”