Three visions of doctoring: a Gadamerian dialogue
Medicine in the twenty-first century faces an ‘identity crisis,’ as it grapples with the emergence of various ‘ways of knowing,’ from evidence-based and translational medicine, to narrative-based and personalized medicine. While each of these approaches has uniquely contributed to the advancement of patient care, this pluralism is not without tension. Evidence-based medicine is not necessary individualized; personalized medicine may be individualized but is not necessarily person-centered. As novel technologies and big data continue to proliferate today, the focus of medical practice is shifting away from the dialogic encounter between doctor and patient, threatening the loss of humanism that many view as integral to medicine’s identity. As medical trainees, we struggle to synthesize medicine’s diverse and evolving ‘ways of knowing’ and to create a vision of doctoring that integrates new forms of medical knowledge into the provision of person-centered care. In search of answers, we turned to twentieth-century philosopher Hans-Georg Gadamer, whose unique outlook on “health” and “healing,” we believe, offers a way forward in navigating medicine’s ‘messy pluralism.’ Drawing inspiration from Gadamer’s emphasis on dialogue and ‘practical wisdom’ (phronesis), we initiated a dialogue with the dean of our medical school to address the question of how medical trainees and practicing clinicians alike can work to create a more harmonious pluralism in medicine today. We propose that implementing a pluralistic approach ultimately entails ‘bridging’ the current divide between scientific theory and the practical art of healing, and involves an iterative and dialogic process of asking questions and seeking answers.
KeywordsMedical education Evidence-based medicine Narrative medicine Personalized medicine Health Philosophy of medicine Gadamer Dialogue
We would like to thank Dr. Pier Bryden for her help with the conception of this piece and her continuous support with preparing the manuscript for publication. We would also like to thank Dr. Ross Upshur and Dr. Ayelet Kuper for their helpful comments on earlier drafts of this paper. We would especially like to acknowledge our patient, Mr. Almeida, on whom this story was based; although the story is true, the details have been changed to protect patient confidentiality.
BCY and AM contributed equally to this work. TY contributed both as an interviewee and in discussion, writing, and reviewing the paper.
- Buber, M. (1970). I and thou. New York: Simon and Schuster.Google Scholar
- Chin-Yee, B, and Upshur R. (2017). Clinical judgement in the era of big data and predictive analytics. Journal of Evaluation in Clinical Practice [Epub ahead of print].Google Scholar
- Gadamer, H. G. (1996). The enigma of health. Stanford: Stanford University Press.Google Scholar
- Gadamer, H. G. (2013). Truth and method. London: Bloomsbury Academic.Google Scholar
- Gauguin, P. (1897). Where do we come from? What are we? Where are we going?. Boston: Museum of Fine Arts.Google Scholar
- Maurer, N. (1998). The pursuit of spiritual wisdom: the thought and art of Vincent Van Gogh and Paul Gauguin. New Jersey: Fairleigh Dickinson University Press.Google Scholar
- Snell, L., Sherbino, J., & Frank, J. R. (2015). CanMEDS 2015 physician competency framework. Ottawa: Royal College of Physicians and Surgeons of Canada.Google Scholar