Promoting critical thinking in health care: phronesis and criticality.

This paper explores the notion of 'expert' health care practitioner in the context of critical thinking and health care education where scientific rather than philosophical inquiry has been the dominant mode of thought. A number of factors have forced a reappraisal in this respect: the challenge brought about by the identification of complex ethical issues in clinical situations; medicine's 'solving' of many of the simple health problems; the recognition that uncertainty is a common and perhaps innate feature of clinical practice; debate about the concepts of illness and disease; plus insights from psychology, sociology and medical anthropology. Together these have prompted alternative ways of thinking which have the aim of identifying the best rather than the right decision (where best equates to good and right equates to correct in the sense of true or approved). It is argued that phronesis adds a necessary corrective dimension to modern Western medicine's over-emphasis on techne and is one of the factors that differentiates novice from expert practitioner. However, this attracts certain conflicts of interest: phronesis can only be gained and assessed from experience of praxis; agencies with legitimate interests in medicine such as government and professional registering bodies require more substantive criteria.