Perspect Biol Med. 2020;63(3):444-457. doi: 10.1353/pbm.2020.0032.
Given the boundless amount of scientific information, clinical skills, and interventional techniques present in biomedicine today, it is impossible for individual physicians and clinicians to have absolute medical knowledge. Further, ambiguity in the interpretation and treatment of illness can lead to significant uncertainty. Despite the inevitability of not knowing in biomedicine, however, there is relatively little academic discussion about how physicians are socialized to address ignorance, how clinicians experience gaps in knowledge as practitioners, or the various forms that not knowing takes in professional health-care practice and education. This article seeks to invigorate new discussions on the role of ignorance and "non-knowledge" in biomedical practice and training. The article critically examines the predominant focus on medical knowledge in the sociological literature and presents a new anthropological framework for the relationship between knowing and not knowing in medicine, called "sufficient knowledge." The author posits that future social and humanistic examinations of biomedicine should seriously consider the ways that physicians navigate ignorance, uncertainty, and not knowing, and that scientists, clinicians, social scientists, and ethicists all have valuable disciplinary perspectives to bring to the conversation around medical ignorance.
鉴于当今生物医学中存在的无限量的科学信息、临床技能和介入技术,单个医生和临床医生不可能拥有绝对的医学知识。此外,疾病的解释和治疗上的模糊性会导致很大的不确定性。尽管在生物医学中不可避免地存在不知道的情况,但关于医生如何被社会化来应对无知、临床医生作为从业者在知识方面的差距、以及不知道在专业医疗保健实践和教育中以何种形式出现等问题,相关学术讨论相对较少。本文旨在为生物医学实践和培训中无知和“非知识”的作用激发新的讨论。本文批判性地考察了社会学文献中对医学知识的主要关注,并提出了一个新的人类学框架,用于研究医学中知与不知之间的关系,称为“足够知识”。作者假设,未来对生物医学的社会和人文研究应该认真考虑医生如何应对无知、不确定性和不知道的方式,科学家、临床医生、社会科学家和伦理学家都可以为围绕医学无知的对话带来有价值的学科视角。