Approaching diagnostic messiness through spiderweb strategies: Connecting epistemic practices in the clinic and the laboratory

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Scientific and medical practice both relate to and differ from each other, as do discussions of how to handle decisions under uncertainty in the laboratory and clinic respectively. While studies of science have pointed out that scientific practice is more complex and messier than dominant conceptions suggest, medical practice has looked to the rigour of scientific and statistical methods to address clinical uncertainty. In this article, we turn to epistemological studies of the laboratory to highlight how clinical practice already has strategies for dealing with messiness. We draw on Hans-Jörg Rheinberger's Toward a History of Epistemic Things, in which he invokes the metaphor of a spider's web to explain the role of tacit practices in experimental biochemistry for helping practitioners manage messiness. We argue that diagnostic practices in clinical medicine employ similar, albeit codified, procedures to evaluate epistemic significance, ensure sensitivity to the unforeseen, and allow focused grounds for action. We consider three practices: (a) the pre-set structure of medical records, ensuring broad coverage in initial anamnesis, (b) the use of lists of differential diagnoses and ongoing ‘anchoring and adjusting’ as inquiry progresses, and (c) shared decision-making as an occasion to synthesize empirical evidence and reopen inquiry for potential missed information. We end by suggesting that while philosophy of medicine may learn from laboratory epistemology, the sciences may learn something from medical practice.

TidsskriftStudies in History and Philosophy of Science
Sider (fra-til)12-21
Antal sider10
StatusUdgivet - 2023

Bibliografisk note

Funding Information:
Both authors wish to thank the Museion Research Group for comments on an early draft, as well as Thomas Bonnin for editorial support, and two anonymous reviewers for comments that improved the structure of the article substantially. Furthermore, Helene Scott-Fordsmand wishes to acknowledge the Carlsberg Foundation for funding during the editing phase of this article, and Karin Tybjerg wishes to acknowledge support from the unrestricted donation from Novo Nordisk Foundation ( NNF18CC0034900 ) funding the Novo Nordisk Foundation Center for Basic Metabolic Research (CBMR) .

Publisher Copyright:
© 2023 The Author(s)

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