A case for Epistemological Methods in Medicine

A case for Epistemological Methods in Medicine

Introduction

Encyclopedia Britannica defines epistemology as the philosophical study of the nature, origin and limits of human knowledge. Clinical medicine on the other hand is the diagnosis and treatment of diseases. When clinical medicine is examined through the lens of epistemology, the purposes of medical education and practice become clearer, allowing for a better basis to design and critique.

Analyzing education

Education is a theme that humankind is preoccupied with, yet itself seems to elude understanding. One of the many ways of looking at education is through the idea of information asymmetry. Information asymmetry is the situation wherein one party in a relationship has access to better or more information than the other. In the case of the teacher student relationship, the teacher enjoys the advantage of information, and by virtue of this advantage is able to transmit to the student. Education is hence the unravelling of information asymmetry.

Analyzing medicine

Medical practice itself consists of a variety of work, including general health promotion, the diagnosis of patients, symptomatic and not; screening for diseases as well subsequent management, including considering complications of diseases and their treatment thereof. Medical education, thus, is the process of conferring upon a student who has read the fundamental sciences, the ability to engage in the professional roles of a practitioner of medicine. It must be said that medical practice too involves information asymmetry. The patient’s complaints are driven by their own understanding of their symptomatology, and the doctor must make what they can out of the presenting complaints to reach a diagnosis. Here, asymmetry acts as a barrier that must be circumvented, and is a key component of the doctor-patient relationship. 

Doctor-patient asymmetry is one of the many reasons why medical practice is crucial to society; it is hence, foundational to the practice of medicine. Medical practitioners are expected to wade through layers of asymmetry, in order to effectively understand what a patient ails from, before deciding on the best possible recourse. While it must be noted that the best models of the doctor-patient relationship also lay stress on communicating disease and treatment details to the patient, it not necessarily an explanation or an unravelling, in the sense that a doctor is expected to tell the patient how long they will have to take tablets, they needn’t and indeed can’t explain how they work. In this way, doctor-patient asymmetry is different from teacher-student asymmetry. While the latter is an entity that the educational process hopes to overcome, the former is an entity that cannot be completely overcome, in hospital settings and must be circumvented to whatever extent possible. This statement can better be understood by unpacking medical education. 

Components of medical education

Medical education begins much before students are enrolled in medical programmes. Students learn the biological and physical sciences in high school, and the curriculum includes portions on human physiology, cell biology and the chemical basis for life. It is with this introduction that medical studies in first year take place, in biochemistry for example, students apply models of ion balance, colloids and biomolecules to clinical scenarios like diabetes and hypertension. In physiology, students continue with the study of organ systems with some garnish of physical concepts like pressure and electricity. Anatomy, is arguably the only subject which is learn afresh in medical school. In second year, students continue to build on their understanding of the body. The subject of pathology is essentially a transposition, where alterations in physiological states produces disease, which manifests itself in signs and symptoms; these include changes to the gross and micro structure of the body. Microbiology borrows heavily from fundamental cell biology as well as physiology to help explain the microbial causation of disease, and pharmacology seamlessly merges high school chemistry with human physiology and pathology, to explain how changes to physiology brought forth by disease can be reversed with drugs. 

Community medicine is the science of appropriating the science of medicine to study entire societies. Epidemiology hopes to answer questions such as how do behaviors induce disease, and how are diseases distributed in a city? This is explained using sociological and mathematical concepts, and brings forth the idea of behavior modification and risk factor control to prevent diseases in the first place. Forensic medicine brings forth legal intricacies associated with medicine. 

The various clinical subjects are essentially built upon this heavy foundational base, while studying symptoms is the terminal step in pathology, clinical medicine starts with symptomology and a search for signs. Using epidemiological and pathological concepts, the genesis of disease and its presentation are explained. This is used to provide a rational framework for investigations and treatment. The student is also expected to know about the course of the disease along with the complications the disease and its treatment. These important skills are conferred in extensive clinical classes.

Hypertension – an example

The above is elaborated by studying hypertension – blood which is pumped by the heart, exerts lateral force on the walls of the blood vessels. The pressure varies from 120 millimeters of mercury at systole, when the heart contracts to 80 millimeters of mercury at diastole, when the heart relaxes. The magnitude of force increases when there is an excess of sodium as sodium induces water retention, or when vessels are constricted owing to Poiseuille’s law. [1] Another cause is the excess presence of some hormones, which alter body metabolism. Excess pressure induces damage to the organs of the body, and the body reacts to this by thickening the walls of vessels and attempting to change balance of some hormones. This induces, in the long term, failure of the bodily organs producing a constellation of clinical conditions, each associated with its own symptoms. Hypertension itself is only associated with a few, vague symptoms like headache.

Increased pressure can be detected clinically using a sphygmomanometer. This device exerts a counter pressure on the vessel wall, which arrests the flow of blood. The practitioner while auscultating with a stethoscope, brings down the pressure in the device, until a sound is heard which indicates the intermittent flow of blood, indicating systole. When the sound ceases to be heard, it means blood flows continuously, meaning diastole has been attainted. Drugs that control blood pressure do so by altering the fluid and ionic balance of the body, or by interacting with complex hormonal systems.

Medicine from the patient’s angle

The patient on the other hand perceives disease through symptoms, such as a swelling on the foot or loss of vision. The patient brings forth their understanding of the disease through what they infer these symptoms to be. A practicing physician must thus try to look for signs based on the history provided by the patient, and confirm the diagnosis through investigations. While these are undoubtedly based on the pathology, there are several layers of knowledge in-between. While a lay person can be told that an inflamed tissue will be red, warm and painful to touch, it will definitely be difficult to explain how that happens. Treatment is even more nuanced, while one can be told that a drug reduces inflammation, how it does so is hard to explain. Similar fates befall the course and the complications of the disease.

Outlook

There is no doubt that what a doctor tells a patient is different from what a teacher tells a student, but how they differ is brought out above. The above exercise represents but a fraction of what epistemology is capable of. Deeper study of epistemology will help us understand how knowledge is generated in the field of medicine, while earlier physicians induced, that is they observed clinical outcomes and came to decisions, later physicians deduced, that is they used the framework of the body they were aware of, to come to clinical decisions. Today, we explain disease and health, through complex pathophysiological models, which explain symptomatology and also help us decide how to investigate. One of the ways scholars look at medicine is through the dichotomy of health and disease, medical education is thus the process of making one able to distinguish from health, disease and return a diseased body to normalcy. This process can be made easier by studying how knowledge itself is organized. Secondly, epistemology will help us bridge the gap between doctors and patients, by letting us study how each group organizes knowledge. This can help reduce misinterpretations and also aid in medical communication. Thus, educational pedagogy [2] and andragogy [3], will certainly benefit from studying [4] the organisation of medical knowledge through the lens of epistemology. 

1. Poiseuille’s law

2. a model of education where students are guided closely

3. a model of education where students are facilitated 

4. Note – to think about thinking is called meta-cognition