"Don't think zebras": uncertainty, interpretation, and the place of paradox in clinical education

Theoretical Medicine
K M Hunter

Abstract

Working retrospectively in an uncertain field of knowledge, physicians are engaged in an interpretive practice that is guided by counterweighted, competing, sometimes paradoxical maxims. "When you hear hoofbeats, don't think zebras," is the chief of these, the epitome of medicine's practical wisdom, its hermeneutic rule. The accumulated and contradictory wisdom distilled in clinical maxims arises necessarily from the case-based nature of medical practice and the narrative rationality that good practice requires. That these maxims all have their opposites enforces in students and physicians a practical skepticism that encourages them to question their expectations, interrupt patterns, and adjust to new developments as a case unfolds. Yet medicine resolutely ignores both the maxims and the tension between the practical reasoning they represent and the claim that medicine is a science. Indeed, resolute epistemological naivete is part of medicine's accommodation to uncertainty; counterweighted, competing, apparently paradoxical (but always situational) rules enable physicians simultaneously to express and to ignore the practical reason that characterizes their practice.

Citations

Jan 5, 1999·BMJ : British Medical Journal·T Greenhalgh, B Hurwitz
Jan 29, 1999·BMJ : British Medical Journal·T Greenhalgh
Dec 17, 2003·Heart·Anna Kiessling
Feb 1, 2011·The British Journal of General Practice : the Journal of the Royal College of General Practitioners·Geraldine M LeydonUNKNOWN QOF Depression Study Team
Mar 8, 2011·The British Journal of General Practice : the Journal of the Royal College of General Practitioners·Trisha Greenhalgh, Geoff Wong
Aug 14, 2009·Journal of Travel Medicine·Issa El-HamadUNKNOWN Migration Health Committee of the ISTM
Dec 21, 2010·The Milbank Quarterly·Trisha Greenhalgh
Jun 27, 2015·The Veterinary Record·Stephen May
Oct 28, 2017·Journal of Evaluation in Clinical Practice·Sabine SallochJochen Vollmann
Oct 11, 2005·Medicine, Health Care, and Philosophy·Stephen Tyreman
Jan 11, 2000·The British Journal of Psychiatry : the Journal of Mental Science·P Webster
Feb 1, 2018·The Journal of Nursing Education·Preetha Krishnan
Sep 16, 2017·Medical Humanities·Birgitte AhlsenEivind Engebretsen
Feb 6, 2018·Journal of Medical Internet Research·Sietse WieringaTrisha Greenhalgh
Aug 30, 2019·Nigerian Medical Journal : Journal of the Nigeria Medical Association·Onome Ogueh
Oct 31, 2020·Advances in Health Sciences Education : Theory and Practice·Nyoli ValentineLambert Schuwirth
Sep 6, 2020·Academic Medicine : Journal of the Association of American Medical Colleges·Margaret BearmanRola Ajjawi

❮ Previous
Next ❯

Related Concepts

Trending Feeds

COVID-19

Coronaviruses encompass a large family of viruses that cause the common cold as well as more serious diseases, such as the ongoing outbreak of coronavirus disease 2019 (COVID-19; formally known as 2019-nCoV). Coronaviruses can spread from animals to humans; symptoms include fever, cough, shortness of breath, and breathing difficulties; in more severe cases, infection can lead to death. This feed covers recent research on COVID-19.

Blastomycosis

Blastomycosis fungal infections spread through inhaling Blastomyces dermatitidis spores. Discover the latest research on blastomycosis fungal infections here.

Nuclear Pore Complex in ALS/FTD

Alterations in nucleocytoplasmic transport, controlled by the nuclear pore complex, may be involved in the pathomechanism underlying multiple neurodegenerative diseases including Amyotrophic Lateral Sclerosis and Frontotemporal Dementia. Here is the latest research on the nuclear pore complex in ALS and FTD.

Applications of Molecular Barcoding

The concept of molecular barcoding is that each original DNA or RNA molecule is attached to a unique sequence barcode. Sequence reads having different barcodes represent different original molecules, while sequence reads having the same barcode are results of PCR duplication from one original molecule. Discover the latest research on molecular barcoding here.

Chronic Fatigue Syndrome

Chronic fatigue syndrome is a disease characterized by unexplained disabling fatigue; the pathology of which is incompletely understood. Discover the latest research on chronic fatigue syndrome here.

Evolution of Pluripotency

Pluripotency refers to the ability of a cell to develop into three primary germ cell layers of the embryo. This feed focuses on the mechanisms that underlie the evolution of pluripotency. Here is the latest research.

Position Effect Variegation

Position Effect Variagation occurs when a gene is inactivated due to its positioning near heterochromatic regions within a chromosome. Discover the latest research on Position Effect Variagation here.

STING Receptor Agonists

Stimulator of IFN genes (STING) are a group of transmembrane proteins that are involved in the induction of type I interferon that is important in the innate immune response. The stimulation of STING has been an active area of research in the treatment of cancer and infectious diseases. Here is the latest research on STING receptor agonists.

Microbicide

Microbicides are products that can be applied to vaginal or rectal mucosal surfaces with the goal of preventing, or at least significantly reducing, the transmission of sexually transmitted infections. Here is the latest research on microbicides.

© 2021 Meta ULC. All rights reserved