Implicit trust in clinical decision-making by multidisciplinary teams.
In clinical practice, decision-making is not performed by individual knowers but by an assemblage of people and instruments in which no one member has full access to every piece of evidence. This is due to decision making teams consisting of members with different kinds of expertise, as well as to o...
| Publicado en: | Synthese Vol. 196; no. 11; pp. 4469 - 4493 |
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| Autores principales: | , |
| Formato: | Artículo |
| Publicado: |
Springer Nature
Nov2019
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=hlh&AN=139254709&site=ehost-live header: @attributes: shortDbName: hlh uiTerm: 139254709 longDbName: Humanities International Complete uiTag: AN controlInfo: bkinfo: jinfo: jid: 00397857 4LI jtl: Synthese issn: 00397857 maglogo: N pubinfo: dt: Nov2019 vid: 196 iid: 11 pid: 237 pub: Springer Nature artinfo: ui: 139254709 10.1007/s11229-017-1475-z ppf: 4469 ppct: 24 formats: fmt: – @attributes: type: T – @attributes: type: P size: 742KB tig: atl: Implicit trust in clinical decision-making by multidisciplinary teams. aug: au: van Baalen, Sophie Carusi, Annamaria affil: Department of Philosophy, University of Twente, Postbus 217, 7500 AE, Enschede, The Netherlands Medical Humanities, University of Sheffield, Sheffield, UK su: Trust Decision making Theory of knowledge Pulmonary hypertension Work in process sug: subj: Trust Decision making Theory of knowledge Pulmonary hypertension Work in process keyword: Clinical decision-making Epistemic dependence Implicit trust Social epistemology Space of reasons ab: In clinical practice, decision-making is not performed by individual knowers but by an assemblage of people and instruments in which no one member has full access to every piece of evidence. This is due to decision making teams consisting of members with different kinds of expertise, as well as to organisational and time constraints. This raises important questions for the epistemology of medicine, which is inherently social in this kind of setting, and implies epistemic dependence on others. Trust in these contexts is a highly complex social practice, involving different forms of relationships between trust and reasons for trust: based on reasons, and not based on reasons; based on reasons that are easily accessible to reflection and others that are not. In this paper, we focus on what it means to have reasons to trust colleagues in an established clinical team, collectively supporting or carrying out every day clinical decision-making. We show two important points about these reasons, firstly, they are not sought or given in advance of a situation of epistemic dependence, but are established within these situations; secondly they are implicit in the sense of being contained or nested within other actions that are not directly about trusting another person. The processes of establishing these reasons are directly about accomplishing a task, and indirectly about trusting someone else's expertise or competence. These processes establish a space of reasons within which what it means to have reasons for trust, or not, gains a meaning and traction in these team-work settings. Based on a qualitative study of decision-making in image assisted diagnosis and treatment of a complex disease called pulmonary hypertension (PH), we show how an intersubjective framework, or 'space of reasons' is established through team members forging together a common way of identifying and dealing with evidence. In dealing with images as a central diagnostic tool, this also involves a common way of looking at the images, a common mode or style of perception. These frameworks are developed through many iterations of adjusting and calibrating interpretations in relation to those of others, establishing what counts as evidence, and ranking different kinds of evidence. Implicit trust is at work throughout this process. Trusting the expertise of others in clinical decision-making teams occurs while the members of the team are busy on other tasks, most importantly, building up a framework of common modes of seeing, and common ways of identifying and assessing evidence emerge. It is only in this way that trusting or mistrusting becomes meaningful in these contexts, and that a framework for epistemic dependence is established. pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: Y custom: Synthese is a copyright of Springer, 2019. All Rights Reserved. item: Synthese holder: Springer Nature dt: @attributes: year: 2019 holdings: @attributes: islocal: N |
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