Epistemic friction, affect and learning to know patients well: setting new norms for medical education

Abstract

Medical education takes seriously the centrality of treating the person and not just the illness. This paper engages with previous work on epistemic and ethical challenges to person-centered care. The aim of the paper is to identify some missing components that medical education must focus on if it wants to inculcate proper epistemic, ethical and affective skills in treating patients well. The argument has four parts: after introducing the problem and providing a background for this paper, I explain the relationship between objectivity and trust. In section II, I inquire into the conditions under which trust in physicians and in the medical establishment can be fostered. I explain the everyday realities of social situatedness that, I argue, must be taken into consideration in order to foster the right kind of objectivity and trust in medical fields. Section III builds on the previous sections by addressing problems of silencing that are systematic and harmful, especially to people from marginalized and minority groups. I draw on Kristie Dotson’s work of testimonial quieting and testimonial smothering in this section and apply it to patients in order to show how important it is to good doctoring practices that physicians learn to develop skills and virtues that address the epistemic problems this essay identifies. Section IV develops the main positive argument. Drawing upon Medina’s account of epistemic vices and virtues that are socially situated and systemically reproduced, I show what a thick notion of epistemic and ethical responsibility would look like. In particular, I argue that physicians need to know how to engage with, rather than remain detached from, epistemic friction in their encounters with patients and that such engagement requires affective sensibilities as well as epistemic and ethical ones. Coming full circle, I return to the starting point of the relationship between objectivity and trustworthiness and argue that struggles to develop a thick notion of physician responsibility in oneself simultaneously is epistemic, ethical, affective, social and political.