Week 9 Flashcards
Phronesis- practical wisdom
Intellectual capacity- an excellence of knowledge
It has a moral orientation towards overall good
It adjudicates when values conflict
It is an executive function (master virtue)
It synthesises knowledge, emotion and reflective practice
It is well suited to the work of a doctor
It aligns with the modern conceptualisation of professionalism
Wisdom in medical decision making
Physicians need wisdom in medical decision making because of the nature of human beings and the illness they experience. The landscape of medicine entails complexity, uncertainty, fluidity, particularity, morality and diversity not to mention technological questions and therapeutic options
Knowledge vs wisdom
Knowledge:
-expires/finite shelf life, knowing “that” facts drives learning, no ethical orientation misused/cunning/power, emotionless (values and feeling hindrance), siloed (specialities, intellectual competition, disjointed), knowledge is an accumulation, can be misapplied out of context, can be measures and assessed “assessment drives learning”, fixed mindset (which is about proving)
Wisdom:
-timeless, practical knowing “how” and knowing “how it feels”, ethical orientation towards flourishing, emotional investment/committed attachment, holistic “all things considered judgement” integrative, wisdom is honed content, contextual and applied informed by experience and/or inspiration, difficult to measure, cognitive/reflective/affective with moral orientation, developmental/growth mindset/mastery
The educational frameworks that shape medical education are bias
Positivism: knowledge is unambiguous and predictable, science is accurate and certain. Context is stripped. Reality is measureable and constant. Researcher is objective (Value free). Outcome is pattern recognition which form new laws and rules reductionist. VOF no interest
Post positivism: knowledge is ambiguous but we can try and explain and put in context, scientific basis context considered, critical realism, values excluded, forms new laws and rules, reductionist, VOF no interest
Critical theory: knowledge is flawed, historical bias has hijacked knowledge, we need to challenge the status quo, values connect researcher and subject, subjective and transactional. Historical realism the world is thought in terms of dominant thought, hopes to bring about change, interpretative. VOF important in upholding altruism and empowerment
Constructivism: knowledge is socially constructed, multiple truths rather than one reality, based on relativism the world exists because of consciousness, accepts multiple conflicting realities about understanding and reconstructing. Interpretative, VOF plays central role
Values
Most values are learned through role modelling and the hidden curriculum
Self awareness
Every feeling is a reminder of something important to us
Our feelings indicate to us what we value
Negative feelings signal a conflict between our values
People have become deaf to the messages in the feelings (repression, venting, avoidance)
Feel through these feelings (feel-appreciate-grapple- reconcile)
Feeling- though all situations= integrity they are grounded in that they know what is important to them and they’ve grappled with the conflicts
With time speed of ‘feeling through’ in new contexts (articulating feelings and values and how they’ve reconciled)=wisdom
At do you need to develop Phronesis
Comprehension- Sunesis recognising moral important features and what goal is
Good sense- Gnome and common sense/intuition (nous)
Intelligence- quick grasp of situation and what needs to be done
Cleverness- Deinotes in executing plan for effective moral action
Wisdom in medicine
Clinicians character/professional virtues
Deliberation of medical decisions making in relation to the goals of medicine -> defined, coordinated, prioritised
Virtuous medical practice research report
Doctors and med student were in agreement about the positive virtues Drs need throughout their career
Fairness
Honesty
Judgement
Kindness
Leadership
Teamwork
Value conflicts in medicine
Honesty v kindness v protection
Autonomy v beneficence
Patient care v family care
Good communication v just enough information
The goals of medicine
Encompass the relief of pain and suffering, the promotion of health and the prevention of disease, the forestalling of death and the promoting of a peaceful death and the cure of disease when possible and the care of those who can not be cured
Death does not mean failure
Doctors can often associate the death of a patient with failure. That is not a fair or healthy association and can lead to huge stress. We are all mortal and so death is a normal part of life. A key part of our job is recognising when someone is approaching the end of life so that the important discussions and decisions can be made. It’s about enabling people to live well for as long as they are alive. We cannot always achieve perfect outcomes. But we can often make things better than they would otherwise be. We do this collaboratively with others (both professionals and patient loved ones). Redefining success to this end is key to healthy boundaries and good EOL Care.
Dr Mike Blaber
The nature of suffering and the goals of medicine
We all recognize certain injuries that almost invariably cause suffering: the death or suffering of loved ones, powerlessness, helplessness, hopelessness, torture, the loss of a life’s work, deep betrayal, physical agony, isolation, homelessness, memory failure, and unremitting fear. Each touches features common to us all, yet each contains features that must be defined in terms of a specific person at a specific time.
Additional dimensions in wise decision making
Probabilities
Tests and treatments
Likelihood of achieving desired outcome/side effects
Patient willingness to endure physical and emotional burden that illness/treatment entails
Care homelessness
Households who are currently experiencing most acute forms of homelessness, rough sleeping, unlicensed squatting or occupation of non residential buildings, living in “unsuitable” temporary accomodation
