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How is medical knowledge made? New methods for research and clinical care have reshaped the practices of medical knowledge production over the last forty years. Consensus conferences, evidence-based medicine, translational medicine, and narrative medicine are among the most prominent new methods. Making Medical Knowledge explores their origins and aims, their epistemic strengths, and their epistemic weaknesses. Miriam Solomon argues that the familiar dichotomy between the art and the science of medicine is not adequate for understanding this plurality of methods. The book begins by tracing the development of medical consensus conferences, from their beginning at the United States' National Institutes of Health in 1977, to their widespread adoption in national and international contexts. It discusses consensus conferences as social epistemic institutions designed to embody democracy and achieve objectivity. Evidence-based medicine, which developed next, ranks expert consensus at the bottom of the evidence hierarchy, thus challenging the authority of consensus conferences. Evidence-based medicine has transformed both medical research and clinical medicine in many positive ways, but it has also been accused of creating an intellectual hegemony that has marginalized crucial stages of scientific research, particularly scientific discovery. Translational medicine is understood as a response to the shortfalls of both consensus conferences and evidence-based medicine. Narrative medicine is the most prominent recent development in the medical humanities. Its central claim is that attention to narrative is essential for patient care. Solomon argues that the differences between narrative medicine and the other methods have been exaggerated, and offers a pluralistic account of how the all the methods interact and sometimes conflict. The result is both practical and theoretical suggestions for how to improve medical knowledge and understand medical controversies.
How is medical knowledge made? New methods for research and clinical care have reshaped the practices of medical knowledge production over the last forty years. Consensus conferences, evidence-based medicine, translational medicine, and narrative medicine are among the most prominent new methods. Making Medical Knowledge explores their origins and aims, their epistemic strengths, and their epistemic weaknesses. Miriam Solomon argues that the familiar dichotomy between the art and the science of medicine is not adequate for understanding this plurality of methods. The book begins by tracing the development of medical consensus conferences, from their beginning at the United States' National Institutes of Health in 1977, to their widespread adoption in national and international contexts. It discusses consensus conferences as social epistemic institutions designed to embody democracy and achieve objectivity. Evidence-based medicine, which developed next, ranks expert consensus at the bottom of the evidence hierarchy, thus challenging the authority of consensus conferences. Evidence-based medicine has transformed both medical research and clinical medicine in many positive ways, but it has also been accused of creating an intellectual hegemony that has marginalized crucial stages of scientific research, particularly scientific discovery. Translational medicine is understood as a response to the shortfalls of both consensus conferences and evidence-based medicine. Narrative medicine is the most prominent recent development in the medical humanities. Its central claim is that attention to narrative is essential for patient care. Solomon argues that the differences between narrative medicine and the other methods have been exaggerated, and offers a pluralistic account of how the all the methods interact and sometimes conflict. The result is both practical and theoretical suggestions for how to improve medical knowledge and understand medical controversies.
How can you make the best use of patient data to improve health outcomes? More and more information about patients' health is stored on increasingly interconnected computer systems. But is it shared in ways that help clinicians care for patients? Could it be better used as a resource for researchers? This book is aimed at all those who want to learn about how IT is transforming the way we think about medicine and medical research. The ideas explored here are taken from research carried out around the world, and are presented by a leading authority in Health Informatics based at University College London. This comprehensive guide to the field is split into three sections: What is health informatics? – an introduction Techniques for representing and analysing patient data and medical knowledge Implementation in the clinical setting: changing practice to improve health care outcomes Whether you are a health professional, NHS manager or IT specialist, this book will help you understand how data can be managed to provide the information you and your colleagues want in the most helpful and accessible way for both you and your patients.
Modern medicine is one of humankind's greatest achievements.Yet today, frequent medical errors and irreproducibility in biomedical research suggest that tremendous challenges beset it. Understanding these challenges and trying to remedy them have driven considerable and thoughtful critical analyses, but the apparent intransigence of these problems suggests a different perspective is needed. Now more than ever, when we see options and opportunities for healthcare expanding while resources are diminishing, it is extremely important that healthcare professionals practice medicine wisely. In Medical Reasoning, neurologist Erwin B. Montgomery, Jr. offers a new and vital perspective. He begins with the idea that the need for certainty in medical decision-making has been the primary driving force in medical reasoning. Doctors must routinely confront countless manifestations of symptoms, diseases, or behaviors in their patients. Therefore, either there are as many different "diseases" as there are patients or some economical set of principles and facts can be combined to explain each patient's disease. The response to this epistemic conundrum has driven medicine throughout history: the challenge is to discover principles and facts and then to develop means to apply them to each unique patient in a manner that provides certainty. This book studies the nature of medical decision making systematically and rigorously in both an analytic and historical context, addressing medicine's unique need for certainty in the face of the enormous variety of diseases and in the manifestations of the same disease in different patients. The book also examines how the social, legal, and economic circumstances in which medical decision-making occurs greatly influence the nature of medical reasoning. Medical Reasoning is essential for those at the intersection of healthcare and philosophy.
Originally published in 1992 Medical Journals and Medical Knowledge examines both broad developments in print and media and the practice of particular journals such as the British Medical Journal. The book is the first study to address these questions and to examine the impact of regular news on the making of the medical community. The book considers the rise of the medical press, and looks at how it recorded and described principal developments and so promoted medical science and enhanced medical consciousness. This book was a seminal work when first published and was one of the first to consider the importance of the roots of medical journalism, editorial practices and the ways in which the medical journalism altered the world of medicine.
In 1748, as yellow fever raged in Charleston, South Carolina, doctor John Lining remarked, "There is something very singular in the constitution of the Negroes, which renders them not liable to this fever." Lining's comments presaged ideas about blackness that would endure in medical discourses and beyond. In this fascinating medical history, Rana A. Hogarth examines the creation and circulation of medical ideas about blackness in the Atlantic World during the late eighteenth and early nineteenth centuries. She shows how white physicians deployed blackness as a medically significant marker of difference and used medical knowledge to improve plantation labor efficiency, safeguard colonial and civic interests, and enhance control over black bodies during the era of slavery. Hogarth refigures Atlantic slave societies as medical frontiers of knowledge production on the topic of racial difference. Rather than looking to their counterparts in Europe who collected and dissected bodies to gain knowledge about race, white physicians in Atlantic slaveholding regions created and tested ideas about race based on the contexts in which they lived and practiced. What emerges in sharp relief is the ways in which blackness was reified in medical discourses and used to perpetuate notions of white supremacy.
Knowledge Coupling discusses the premises upon which the coupling of knowledge to every action is based in the practice of medicine, as well as why these premises must change. In concrete terms, the volume explores the methods of structuring and using medical knowledge and medical records that enables implementation of new premises; it sets forth a specific approach to use of the computer. The work examines the new roles and skills that will be demanded of both patients and health care providers within the system based on these new premises. The author takes into account the broad implications of his philosophy for the social, economic, educational, and political structuring of the health care system.
However much the three great traditions of medicine - Galenic, Chinese and Ayurvedic - differed from each other, they had one thing in common: scholarship. The foundational knowledge of each could only be acquired by careful study under teachers relying on ancient texts. Such medical knowledge is special, operating as it does in the realm of the most fundamental human experiences - health, disease, suffering, birth and death - and the credibility of healers is of crucial importance. Because of this, scholarly medical knowledge offers a rich field for the study of different cultural practices in the legitimation of knowledge generally. The contributors to this volume are all specialists in the history or anthropology of these traditions, and their essays range from historical investigations to studies of present-day practices.
A guide for everyone involved in medical decision making to plot a clear course through complex and conflicting benefits and risks.
The growth of knowledge and its effects on the practice of medicine have been issues of philosophical and ethical interest for several decades and will remain so for many years to come. The outline of the present volume was conceived nearly three years ago. In 1987, a conference on this theme was held in Maastricht, the Netherlands, on the occasion of the founding of the European Society for Philosophy of Medicine and Health Care (ESPMH). Most of the chapters of this book are derived from papers presented at that meeting, and for the purpose of editing the book Stuart Spicker, Ph. D. , joined two founding members of ESPMH, Henk ten Have and Gerrit Kimsma. The three of them successfully brought together a number of interesting contribu tions to the theme, and ESPMH is grateful and proud to have initiated the production of this volume. The Society intends that annual meetings be held in different European countries on a rotating basis and to publish volumes related to these meetings whenever feasible. In 1988, the second conference was held in Aarhus, Denmark on "Values in Medical Decision Making and Resource Allocation in Health Care". In 1989, a meeting was held in Czestochowa, Poland, on "European Traditions in Philosophy of Medicine. From Brentano to Bieganski". It is hoped that these conferences and the books to be derived from them, will initiate a new European tradition, lasting well into the 21 st century! P. J.