Skip to main content Accessibility help
×
Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-20T01:16:51.811Z Has data issue: false hasContentIssue false

31 - Wisdom in Medical Decision-Making

from Part VII - Wisdom in Action

Published online by Cambridge University Press:  15 March 2019

Robert J. Sternberg
Affiliation:
Cornell University, New York
Judith Glück
Affiliation:
Universität Klagenfurt, Austria
Get access

Summary

Physicians need wisdom in medical decision-making because of the nature of illness and the questions that come with advances in biomedical science and the spread of therapeutic options. Interpretations of wisdom in the literature and practice of medicine reveal two principal accounts. One identifies wisdom as a constellation of virtues that are part of the character of the physician. The other identifies wisdom as a specific practical virtue manifested through deliberation about goals of care and other elements of medical decision-making. In medicine, wisdom is closely related to ethics because both are directed toward the good of a patient, which includes health, dignity, and freedom. This good is promoted through shared decision-making that requires respectful dialogue aimed at the patient’s best interests. Gaining wisdom requires training and practice in professional communities that include role models, shared narratives, and reflection on experience, especially when external forces challenge the expression of wisdom in the patient–physician relationship. Overall, wisdom reminds the physician that medicine is a moral practice that calls for an integrated understanding of science and ethics that allows physicians to treat patients as persons who have illnesses, rather than as bodies that have diseases.
Type
Chapter
Information
Publisher: Cambridge University Press
Print publication year: 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aaron, H. J. (2017). Which road to universal coverage? New England Journal of Medicine, 377(23), 2207–9.CrossRefGoogle ScholarPubMed
Arthur, J., Kristjánsson, K., Thomas, H., Kotzee, B., Ignatowicz, A., & Qiu, T. (2015). Virtuous Medical Practice. Retrieved from Birmingham, UK. www.jubileecentre.ac.uk/userfiles/jubileecentre/pdf/Research%20Reports/Virtuous_Medical_Practice.pdfGoogle Scholar
Beauchamp, T. L., & Childress, J. F. (2009). Principles of Biomedical Ethics (6th ed.). New York, NY: Oxford University Press.Google Scholar
Beresford, E. B. (1996). Can phronesis save the life of medical ethics? Theoretical Medicine, 17, 209–24.CrossRefGoogle ScholarPubMed
Branch, W. T., & Mitchell, G. A. (2011). Wisdom in medicine. Pharos of Alpha Omega Alpha-Honor Medical Society, 74(3), 1217.Google ScholarPubMed
Brandt, D. S., Shinkunas, L. A., Gehlbach, T. G., & Kaldjian, L. C. (2012). Understanding goals of care statements and preferences among patients and their surrogates in the medical ICU Journal of Hospice and Palliative Nursing, 14(2), 126–32.CrossRefGoogle ScholarPubMed
Callahan, S. (1991). In good conscience: Reason and emotion in moral decision making. New York, NY: Harper Collins.Google Scholar
Casalino, L. P. (2013). Professionalism and caring for Medicaid patients – the 5% commitment? New England Journal of Medicine, 369(19), 1775–7.CrossRefGoogle Scholar
Charles, C., Gafni, A., & Whelan, T. (1997). Shared decision–making in the medical encounter: What does it mean? (Or it takes at least two to tango). Social Science and Medicine, 44(5), 681–92.CrossRefGoogle ScholarPubMed
Charles, C., Whelan, T., & Gafni, A. (1999). What do we mean by partnership in making decisions about treatment? British Medical Journal, 319, 780–2.CrossRefGoogle ScholarPubMed
Cram, P., Dhalla, I., & Kwan, J. L. (2017). Trade-offs: Pros and cons of being a doctor and patient in Canada. Journal of General Internal Medicine, 32(5), 563–5.CrossRefGoogle ScholarPubMed
Crawshaw, R., Rogers, D. E., Pellegrino, E. D., Bulger, R. J., Lundberg, G. D., Bristow, L. R., et al. (1995). Patient-physician covenant. Journal of the American Medical Association, 273, 1553.CrossRefGoogle ScholarPubMed
Daschle, T., Domenici, P., Frist, W., & Rivlin, A. (2013). Prescription for patient-centered care and cost containment. New England Journal of Medicine, 369(5), 471–4.CrossRefGoogle ScholarPubMed
DeCamp, M., & Riggs, K. R. (2016). Navigating ethical tensions in high-value care education. Journal of the American Medical Association, 316(21), 2189–90.Google ScholarPubMed
Doherty, R. (2015). Assessing the patient care implications of “concierge” and other direct patient contracting practices: A policy position paper from the American College of Physicians. Annals of Internal Medicine, 163, 949–52.CrossRefGoogle ScholarPubMed
Dumont, D. M., Oh, J., & Cooper, T. (2017). State-level surveillance of underinsurance and health care-related financial burden. Journal of Public Health Management & Practice, 23(5), e10e16.CrossRefGoogle ScholarPubMed
Edmondson, R., & Pearce, J. (2007). The practice of health care: Wisdom as a model. Medicine, Health Care and Philosophy, 10(3), 233–44.CrossRefGoogle ScholarPubMed
Edmondson, R., Pearce, J., & Woerner, M. H. (2009). Wisdom in clinical reasoning and medical practice. Theoretical Medicine and Bioethics, 30(3), 231–47.CrossRefGoogle ScholarPubMed
Elwyn, G., Frosch, D., Thomson, R., Joseph-Williams, N., Lloyd, A., Kinnersley, P., et al. (2012). Shared decision making: A model for clinical practice. Journal of General Internal Medicine, 27(10), 1361–7.CrossRefGoogle Scholar
Epstein, R. M. (2008). Reflection, perception and the acquisition of wisdom. Medical Education, 42(11), 1048–50.CrossRefGoogle ScholarPubMed
Epstein, R. M., Siegel, D. J., & Silberman, J. (2008). Self-monitoring in clinical practice: A challenge for medical educators. Journal of Continuing Education in the Health Professions, 28(1), 513.CrossRefGoogle ScholarPubMed
Gaufberg, E. H., Batalden, M., Sands, R., & Bell, S. K. (2010). The hidden curriculum: What can we learn from third-year medical student narrative reflections? Academic Medicine, 85, 1709–16.CrossRefGoogle ScholarPubMed
Gelhaus, P. (2012). The desired moral attitude of the physician: (I) empathy. Medicine, Health Care and Philosophy, 15, 103–13.Google ScholarPubMed
Glück, J., & Bluck, S. (2013). The MORE life experience model: A theory of the development of personal wisdom. In Ferrari, M. & Weststrate, N. M. (Eds.), The scientific study of personal wisdom: From contemplative traditions to neuroscience (pp. 7597). Dordrecht, Netherlands: Springer.Google Scholar
Glück, J., Konig, S., Naschenweng, K., Redzanowski, U., Dorner, L., Strasser, I., et al. (2013). How to measure wisdom: Content, reliability, and validity of five measures. Frontiers in Psychology, 4, 405.CrossRefGoogle ScholarPubMed
Goitein, L. (2014). The argument against reimbursing physicians for value. JAMA Internal Medicine, 174(6), 845–6.CrossRefGoogle ScholarPubMed
Gourevitch, M. N. (2014). Population health and the academic medical center: The time is right. Academic Medicine, 89, 544–9.CrossRefGoogle ScholarPubMed
Grossmann, I. (2017). Wisdom in context. Perspectives on Psychological Science, 12(2), 233–57.CrossRefGoogle ScholarPubMed
Haberle, T. H., Shinkunas, L. A., Erekson, Z. D., & Kaldjian, L. C. (2011). Goals of care among hospitalized patients: A validation study. American Journal of Hospice and Palliative Medicine, 28, 335–41.CrossRefGoogle ScholarPubMed
Hafferty, F. W., & Franks, R. (1994). The hidden curriculum, ethics teaching, and the structure of medical education. Academic Medicine, 69(11), 861–71.CrossRefGoogle ScholarPubMed
Halpern, J. (2001). From detached concern to empathy: Humanizing medical practice. Oxford: Oxford University Press.CrossRefGoogle Scholar
Henry, C. W. (1993). The place of prudence in medical decision making. Journal of Religion and Health, 32, 2737.CrossRefGoogle ScholarPubMed
Kaldjian, L. C. (2013). Communicating moral reasoning in medicine as an expression of respect for patients and integrity among professionals. Communication & Medicine, 10, 177–83.Google Scholar
Kaldjian, L. C. (2014a). Practicing medicine and ethics: Integrating wisdom, conscience, and goals of care. New York, NY: Cambridge University Press.CrossRefGoogle Scholar
Kaldjian, L. C. (2014b). Patient care and population health: goals, roles and costs. Journal of Public Health Research, 3(2), 311.CrossRefGoogle ScholarPubMed
Kaldjian, L. C. (2017). Concepts of health, ethics, and communication in shared decision making. Communication & Medicine, 14(1), 8395.CrossRefGoogle ScholarPubMed
Kaldjian, L. C., Curtis, A. E., Shinkunas, L. A., & Cannon, K. T. (2009). Goals of care toward the end of life: A structured literature review. American Journal of Hospice and Palliative Medicine, 25, 501–11.CrossRefGoogle Scholar
Kotzee, B., & Ignatowicz, A. (2016). Measuring ‘virtue’ in medicine. Medicine, Health Care and Philosophy, 19(2), 149–61. doi: 10.1007/s11019–015–9653–6CrossRefGoogle ScholarPubMed
Kotzee, B., Paton, A., & Conroy, M. (2016). Towards an empirically informed account of phronesis in medicine. Perspectives in Biology and Medicine, 59(3), 337–50.CrossRefGoogle ScholarPubMed
Levenstein, J. H., Brown, J. B., Weston, W. W., Stewart, M., McCracken, E. C., & McWhinney, I. (1989). Patient-centered clinical interviewing. In Stewart, M. & Roter, D. (Eds.), Communicating with medical patients (pp. 107–20). Newbury Park, CA: Sage.Google Scholar
Linzer, M., Bitton, A., Shin-Ping, T., Plews-Ogan, M., Horowitz, K. R., & Schwartz, M. D. (2015). The end of the 15-20 minute primary care visit. Journal of General Internal Medicine, 30(11), 1584–6.CrossRefGoogle ScholarPubMed
MacIntyre, A. (1984). After virtue. Notre Dame, IN: University of Notre Dame Press.Google Scholar
MacIntyre, A. (1999). Social structures and their threats to moral agency. Philosophy, 74, 311–29.CrossRefGoogle Scholar
Mackenzie, C. (2008). Relational autonomy, normative authority and perfectionism. Journal of Social Philosophy, 39(4), 512–33.CrossRefGoogle Scholar
Marcum, J. A. (2012). The virtuous physician: The role of virtue in medicine. Dordrecht: Springer.CrossRefGoogle Scholar
Meilaender, G. C. (1984). The theory and practice of virtue. Notre Dame, IN: University of Notre Dame Press.Google Scholar
Montgomery, K. (2006). How doctors think: Clinical judgment and the practice of medicine. Oxford, England: Oxford University Press.Google Scholar
Niebuhr, R. (1960). The children of light and the children of darkness. New York, NY: Charles Scribner's Sons.Google Scholar
O'Donovan, O. (2013). Self, world, and time. Grand Rapids, MI: Eerdmans Publishing Company.Google Scholar
O'Rourke, K. (2000). A primer for health care ethics: Essays for a pluralist society (2nd ed.). Washington, DC: Georgetown University Press.Google Scholar
Parker, M. (2002). Whither our art? Clinical wisdom and evidence-based medicine. Medicine, Health Care and Philosophy, 5, 273–80.CrossRefGoogle ScholarPubMed
Pellegrino, E. D. (1979). Humanism and the physician. Knoxville, TN: University of Tennessee Press.Google Scholar
Pellegrino, E. D. (1985). The virtuous physician, and the ethics of medicine. In Shelp, E. E. (Ed.), Virtue and medicine (pp. 237–55). Dordrecht: D. Reidel Publishing Company.Google Scholar
Pellegrino, E. D., & Thomasma, D. C. (1993). The virtues in medical practice. New York, NY: Oxford University Press.CrossRefGoogle Scholar
Physicians Foundation. (2016). 2016 Survey of America's Physicians: Practce Patterns & Perspectives. Retrieved from www.physiciansfoundation.orgGoogle Scholar
Pieper, J. (1966). The four cardinal virtues. Notre Dame, IN: University of Notre Dame Press.Google Scholar
Plews-Ogan, M., May, N., Owens, J., Ardelt, M., Shapiro, J., & Bell, S. K. (2016). Wisdom in medicine: What helps physicians after a medical error? Academic Medicine, 91(2), 233–41.CrossRefGoogle Scholar
Plews-Ogan, M., Owens, J. E., & May, N. B. (2013). Wisdom through adversity: learning and growing in the wake of an error. Patient Education and Counseling, 91(2), 236–42.CrossRefGoogle ScholarPubMed
Quinn, K. (2015). The 8 basic payment methods in health care. Annals of Internal Medicine, 163, 300–6.CrossRefGoogle ScholarPubMed
Schön, D. A. (1983). The reflective practitioner: How professionals think in action. United States: Basic Books.Google Scholar
Siegler, M. (1981). The doctor-patient encounter and its relationship to theories of health and disease. In Caplan, A. L., Engelhardt, H. T., & McCartney, J. J. (Eds.), Concepts of health and disease: Interdisciplinary perspectives (pp. 627–44). London: Addison-Wesley Publishing Company.Google Scholar
Sinsky, C., Colligan, L., Li, L., Prgomet, M., Reynolds, S., Goeders, L., et al. (2016). Allocation of physician time in ambulatory practice: A time and motion study in 4 specialties. Annals of Internal Medicine, 165, 753–60.CrossRefGoogle Scholar
Sulmasy, D. P. (2000). Should medical schools be schools for virtue? Journal of General Internal Medicine, 15, 514–16.CrossRefGoogle ScholarPubMed
Sulmasy, L. S., Lopez, A. M., & Horwitch, C. A. (2017). Ethical implications of the electronic health record: In the service of the patient. Journal of General Internal Medicine, 32(8), 935–9.CrossRefGoogle ScholarPubMed
Svenaeus, F. (2003). Hermeneutics of medicine in the wake of Gadamer: The issue of phronesis. Theoretical Medicine and Bioethics, 24, 407–31.CrossRefGoogle ScholarPubMed
Svenaeus, F. (2014). Empathy as a necessary condition of phronesis: A line of thought for medical ethics. Medicine, Health Care and Philosophy, 17(2), 293–9.CrossRefGoogle ScholarPubMed
Szawarski, Z. (2004). Wisdom and the art of healing. Medicine, Health Care and Philosophy, 7, 185–93.CrossRefGoogle ScholarPubMed
Tilburt, J. C., Wynia, M. K., Sheeler, R. D., Thorsteinsdottir, B., James, K. M., Egginton, J. S., et al. (2013). Views of US physicians about controlling health care costs. Journal of the American Medical Association, 310(4), 380–8.Google ScholarPubMed
Tyreman, S. (2000). Promoting critical thinking in health care: Phronesis and criticality. Medicine, Health Care and Philosophy, 3, 117–24.CrossRefGoogle ScholarPubMed
Westsrate, N. M., & Glück, J. (2017). Hard-earned wisdom: Exploratory processing of difficult life experience is positively associated with wisdom. Developmental Psychology, 53(4), 800–14.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×