Most clinicians take for granted a simple, reductionist understanding of medical knowledge that is at odds with how they actually practice medicine; routine medical decisions incorporate more complicated kinds of information than most standard accounts of medical reasoning suggest. A better understanding of the structure and function of knowledge in medicine can lead to practical improvements in clinical medicine. This understanding requires some familiarity with epistemology, the study of knowledge and its structure, in medicine. Michael Polanyi's theory of tacit knowing (...) is advanced as the basis for developing a more accurate understanding of medical knowledge. Tacit knowing, which explores the taken-for-granted background knowledge that underlies all human knowing, is explained in detail with a focus on its relevance for clinical medicine. The implications of recognizing tacit knowing in medicine and medical decisions are discussed. These include the ability to explain the importance of the clinical encounter in medical practice, mechanisms for analysing patient and doctor as persons, and the need for humility given the uncertainty that the tacit dimension injects into all medical decisions. This more robust medical epistemology allows clinicians to better articulate the nature and importance of patient-centred care, to avoid pitfalls inherent in reductionist approaches to medical knowledge, and to think more clearly about the relationships between medicine and health care at the individual and population levels. (shrink)

Scientific and political developments of the early twentieth century led Michael Polanyi to study the role of the scientist in research and the interaction between the individual scholar and the surrounding conditions in community and society. In his concept of “personal knowledge” he gave the theory and history of science an anthropological turn. In many instances of the history of sciences, research is driven by a commitment to beliefs and values. Society plays the role of authority and communicative backdrop that (...) presupposes individual liberty. As a system of beliefs science is rooted in community and also in history. However, as soon as fellow humans become the objects of research, their appeal transcends the researcher. Consequently, the history of human endeavor reveals a “firmament” of standards and obligations which represent an ontological reality, for which Polanyi invokes Teilhard de Chardin’s notion of noosphere. (shrink)