Knowing – in Medicine
Article first published online: 31 OCT 2008
© 2008 The Authors. Journal compilation © 2008 Blackwell Publishing Ltd
Journal of Evaluation in Clinical Practice
Special Issue: Evidence Based Medicine
Volume 14, Issue 5, pages 767–770, October 2008
How to Cite
Sturmberg, J. P. and Martin, C. M. (2008), Knowing – in Medicine. Journal of Evaluation in Clinical Practice, 14: 767–770. doi: 10.1111/j.1365-2753.2008.01011.x
- Issue published online: 31 OCT 2008
- Article first published online: 31 OCT 2008
- Accepted for publication:27 February 2008
- Cynefin framework;
- medical epistemology;
- narrative medicine;
- philosophy of medicine;
In this paper we argue that knowledge in health care is a multidimensional dynamic construct, in contrast to the prevailing idea of knowledge being an objective state. Polanyi demonstrated that knowledge is personal, that knowledge is discovered, and that knowledge has explicit and tacit dimensions.
Complex adaptive systems science views knowledge simultaneously as a thing and a flow, constructed as well as in constant flux. The Cynefin framework is one model to help our understanding of knowledge as a personal construct achieved through sense making. Specific knowledge aspects temporarily reside in either one of four domains – the known, knowable, complex or chaotic, but new knowledge can only be created by challenging the known by moving it in and looping it through the other domains.
Medical knowledge is simultaneously explicit and implicit with certain aspects already well known and easily transferable, and others that are not yet fully known and must still be learned. At the same time certain knowledge aspects are predominantly concerned with content, whereas others deal with context.
Though in clinical care we may operate predominately in one knowledge domain, we also will operate some of the time in the others. Medical knowledge is inherently uncertain, and we require a context-driven flexible approach to knowledge discovery and application, in clinical practice as well as in health service planning.