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

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.

Reversing the medical humanities.

The paper offers the concept of reversing the medical humanities In agreement with the call from Kristeva et al to recognise the bidirectionality of the medical humanities, I propose moving beyond debates of attitude and aptitude in the application and engagement (either friendly or critical) of humanities to/in medicine, by considering a reversal of the directions of epistemic movement (a reversal of the flow of knowledge). I situate my proposal within existing articulations of the field found in the medical humanities meta-literature, pointing to a gap in the current terrain. I then develop the proposal by unfolding three reasons why we might gain something from exploring a reversed knowledge flow. First, a reversed knowledge flow seems to be an inherent-but still to be articulated-possibility in medical humanities and thus provides an opportunity for more knowledge. Second, the current unidirectionality of the field is founded on an inconsistency in the depiction of the connection between medicine and humanities, which risks creating the very divide that medical humanities set out to bridge. Practising a reversal may help avoid this divide. And third, a reversal might help rebalance the internal epistemic power, so as to motivate less external scepticism and in turn displace more external epistemic power towards medical humanities. I end the paper with a remark on precursors for a reversal, and ideas for where to go from here.

Evaluating emotions in medical practice: a critical examination of 'clinical detachment' and emotional attunement in orthopaedic surgery.

In this article I propose to reframe debates about ideals of emotion in medicine, abandoning the current binary setup of this debate as one between 'clinical detachment' and empathy. Inspired by observations from my own field work and drawing on Sky Gross' anthropological work on rituals of practice as well as Henri Lefebvre's notion of rhythm, I propose that the normative drive of clinical practice can be better understood through the notion of attunement. In this framework individual types of emotions are not, as such, appropriate or inappropriate, but are evaluated depending on their synchronicity with the specific rhythms of the practice. To set up this proposal, I show how typical arguments about emotions in medicine-what I call emotion-entity focused frameworks-are insufficient. I then draw on ethnographic observations from two orthopaedic departments and interviews with medical practitioners to show (1) how clinical practice is driven by rhythmicity, shaped in the case of orthopaedic surgery by a clinical aim of efficient, controlled intervention, and (2) how clinicians continuously refer to this drive and the flow of rhythms when evaluating inappropriate or problematic emotion. I argue that the use of a rhythm framework rather than ideals of detachment or empathy allows for a sensitivity to the complexity and situation-dependent elements of emotional ideals in clinical practice; and I end by proposing the term 'attuned concern'-which stresses the importance of regulation and adjustment to circumstances rather than of maintaining a constant distance/involvement-as a more fitting alternative to 'clinical detachment'.

From Contact to Enact: Reducing Prejudice Toward Physical Disability Using Engagement Strategies.

The contact hypothesis has dominated work on prejudice reduction and is often described as one of the most successful theories within social psychology. The hypothesis has nevertheless been criticized for not being applicable in real life situations due to unobtainable conditions for direct contact. Several indirect contact suggestions have been developed to solve this "application challenge." Here, we suggest a hybrid strategy of both direct and indirect contact. Based on the second-person method developed in social psychology and cognition, we suggest working with an engagement strategy as a hybrid hypothesis. We expand on this suggestion through an engagement-based intervention, where we implement the strategy in a theater performance and investigate the effects on prejudicial attitudes toward people with physical disabilities. Based on the results we reformulate our initial engagement strategy into the Enact (Engagement, Nuancing, and Attitude formation) hypothesis. To deal with the application challenge, this hybrid hypothesis posits two necessary conditions for prejudice reduction. Interventions should: (1) work with engagement to reduce prejudice, and (2) focus on the second-order level of attitudes formation. Here the aim of the prejudice reduction is not attitude correction, but instead the nuancing of attitudes.