Skilled Know-How, Virtuosity, and Expertise in Clinical Practice

Abstract

The terms “skilled know-how,” “virtuosity,” and “expertise” all denote forms of technical mastery. Applied to medicine they refer to different aspects of medical expertise. Yet, what exactly is medical expertise? Is it a kind of cognition, or action, or a combination of both? Additionally, what aspects of clinical practice does technical expertise refer to? In this chapter technical expertise in clinical practice is analyzed in terms of three identified components: cognition, motoric action, and interpersonal relations. Furthermore, the three components of technical mastery are related to Aristotle’s concept of practical wisdom, or phronesis. In his Nicomachean Ethics, Aristotle differentiated between two different forms of human action: techne and phronesis. In broad terms techne refers to an action that results in the production of external objects, while phronesis refers to an action that has its end in itself. This distinction provides the architectonic keystone of this analysis of expertise in clinical practice. This approach presents an alternative to the predominant cognitive conception H.D. Braude (*) The Mifne Center, Rosh Pinna, Israel e-mail: hillel.braude@mcgill.ca # Springer Science+Business Media Dordrecht 2015 T. Schramme, S. Edwards (eds.), Handbook of the Philosophy of Medicine, DOI 10.1007/978-94-017-8706-2_68-1 1 of technical expertise in clinical practice. A full understanding of technical expertise, skilled know-how, and virtuosity is not possible without highlighting the important role of intentionality in action and other forms of pre-reflective knowing in clinical practice. Definition of Key Terms Action A movement of the body, resulting from specific mental preparation and aimed at some goal that the agent desires to achieve. Cognition All mental processes related to knowledge, including but not limited to memory, attention, perception, representational schemas, consciousness, and language. Doctrine of double effect Ethical principle that gives moral legitimacy to an equivocal action provided that the good and not harmful effect is intended, even though the unintended harmful effect may be foreseen. Metacognition The processes involved in thinking about and monitoring one’s own cognitive activity. Phenomenological introspection Philosophical method to become self-aware of prereflective states of consciousness. Praxis Practical activity that is intended to further human well-being or the good and is not associated with any particular end product external to the act. Poiesis Any human activity that results in a product external to the human activity itself. Phronesis The moral capability to evaluate the means and ends of a particular action. In clinical reasoning phronesis affords the means of linking and integrating different cognitive processes. Tacit Knowing Knowledge that functions at the periphery of attention and makes explicit knowledge possible. Techne An action associated with craftsmanship, resulting in the production of external objects. 2 H.D. Braude