[Wisdom--knowledge, the patient and the physician].
Evidence-based medicine and treatment protocols are necessary, but not sufficient tools for the clinical doctor. Practical skills, clinical acumen, and sensitivity are also prerequisites for first-rate practice. The focus of this article is the clinical wisdom which an experienced doctor expresses and adds to the clinical setting. Clinical wisdom is difficult to define, though it is visible in producing consultation outcomes that are optimal for the patient as well as the doctor. We discuss these outcomes in relation to the individualisation of medical knowledge, the doctor-patient relationship, and the doctor's relationship to his private self. On its way from scientific paper to clinical decision, knowledge has to be reviewed time and again--a complicated task, indeed, but the burden on the clinician is even greater. In a consultation, abstract knowledge is confronted with the unique characteristics of the patient. Patient characteristics deviate from scientific knowledge in being anecdotal, narrative and open to hermeneutic interpretation, but the doctor must incorporate them in his decision-making by an understanding which may go beyond the patient's understanding of himself. In doing so, the doctor faces bereavement, death and sorrow which affects the doctor's own existential understanding and reminds him of his own vulnerability. We do well to recognise and accept this aspect of clinical practice.
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D002983:Clinical Competence; D003657:Decision Making; D004645:Empathy; D006801:Humans; D019359:Knowledge; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology