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Despite experience‐based expertise being increasingly common in health care, what experiential knowledge consists of remains a topic for debate. Here I propose a philosophical approach to clarify experiential knowledge, drawing on an analogous debate in philosophy of mind, which similarly targets the intuition that experience may generate unique knowledge. I outline the philosophical debate and explicate some relevant ideas for health care, so as to (a) evaluate whether and to what extent this analogous debate is helpful, and (b) supplement existing ideas on experiential knowledge with a philosophical analysis. [ABSTRACT FROM AUTHOR]

Patients are interested in receiving accurate diagnostic and prognostic information. Models and reasoning about diagnoses have been extensively investigated from a foundational perspective; however, for all its importance, prognosis has yet to receive a comparable degree of philosophical and methodological attention, and this may be due to the difficulties inherent in accurate prognostics. In the light of these considerations, we discuss a considerable body of critical thinking on the topic of prognostication and its strict relations with diagnostic reasoning, pointing out the distinction between nosographic and pathophysiological types of diagnosis and prognosis, underlying the importance of the explication and explanation processes. We then distinguish between various forms of hypothetical reasoning applied to reach diagnostic and prognostic judgments, comparing them with specific forms of abductive reasoning. The main thesis is that creative abduction regarding clinical hypotheses in diagnostic process is very unlikely to occur, whereas this seems to be often the case for prognostic judgments. The reasons behind this distinction are due to the different types of uncertainty involved in diagnostic and prognostic judgments. [ABSTRACT FROM AUTHOR]

How does schizophrenia affect a subject's sense of self? In this paper, we discuss the experience of alienation of mental states and actions that can take place in schizophrenia. We begin by highlighting this experience in delusions of thought insertion and delusions of made feelings, impulses and actions. Next, we offer a proposal about the nature of this experience by utilizing some of the current philosophical research on self-knowledge. The proposal is that the experience of thoughts, feelings, impulses and actions as not being one's own is the experience of regarding those states as not being responsive to reasons. Then, we put forward a hypothesis about why schizophrenia can lead to this experience by drawing on the psychiatric literature on the disorder. The hypothesis is that subjects who suffer the four delusions are unable to regard some of their thoughts, feelings, impulses and actions as being responsive to reasons because they suffer from a tendency to focus their attention on their own perceptual experiences, as opposed to focusing it on the world. The lesson to draw from the alienation of mental states and actions caused by schizophrenia will be, finally, that two separate components normally make up our sense of self; two components that turn out to be dissociated in the four schizophrenic delusions discussed. These are, on the one hand, the self as the bearer, or host, of mental states and actions and, on the other hand, the self as the owner and agent, respectively, of those mental states and actions. [ABSTRACT FROM AUTHOR]

Following my own involvement in the rise of evidence-based medicine in General Practice in the UK, and having seen how this tide has led to a relative devaluation of other kinds of knowing this paper sets out four alternative approaches to the problem of knowledge in a way which both undermines the predominance of a strictly evidence-based approach and re-emphasizes these other means through which we come to know the world. Philosophically, this brings together the works of Heidegger, Sebald, Bachelard and Gadamer and shows how these apparently disparate authors suggest that there is, underlying our empirical understanding of the world, a more primordial relationship between consciousness and world which supports empirical or evidence-based knowledge and without which evidence-based knowledge cannot be applied in practice. The implications for clinical practice of this kind of thinking should be a more cautious approach to the use of evidence and a greater emphasis and reliance on the discretion and judgement of clinical professionals. [ABSTRACT FROM AUTHOR]

Strand and Parkkinen criticize our dispositional account of causation in evidence-based medicine for failing to provide a proper epistemology of causal knowledge. In particular, they claim that we do not explain how causal inferences should be drawn. In response, we point out that dispositionalism does indeed have an account of the epistemology of causation, including counterfactual dependence, intervention, prediction and clinical decision. Furthermore, we argue that this is an epistemology that fits better with the known fallibility of even our best-informed predictions. Predictions are made on the basis that causes dispose or tend towards their effects, rather than guarantee them. The ontology of causation remains a valuable study for, among other reasons, it tells us that powers do not always combine additively. This counts against the monocausality that is tested by randomized controlled trials. [ABSTRACT FROM AUTHOR]

In this article the author discusses the alternatives to a reductive view of knowledge in the medical practice, in a response to an essay by Derek Mitchell suggesting the inclusion of philosophy and literature in clinical knowledge published within the journal. The author regarded the essay to be provocative and contains important insights, however, he notes on the inadequacy of the concluding section. A brief overview of the essay is presented.