This article engages with medical practice to develop a philosophically informed understanding of epistemic engagement in medicine, and epistemic object relations more broadly. I take my point of departure in the clinical encounter and draw on French psychoanalytical theory to develop and expand a taxonomy already proposed by Karin Knorr-Cetina. In so doing, I argue for the addition of an abject-type object relation; that is, the encounter with objects that transgress frameworks and disrupt further investigation, hence preventing dynamic engagement and (...) negatively shaping our epistemic pathways. This article is primarily theoretical, although partly grounded in qualitative fieldwork. (shrink)