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The Thought Style of Physicians

Strategies for Keeping up with Medical Knowledge

Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, R.S. Fco. Xavier, 524, 7o Andar Bloco D, Rio de Janeiro, RJ, 20559–900, Brazil; fax: +55 21 2264 1142 or+55 21 2569 3077;kenneth{at}uerj.brorkenneth.rochel{at}terra.com.br

The differential selection and assessment of knowledge is a key feature of medical practice. This paper presents a study of how doctors select and assess information in practice. Fourteen internal medicine professors from a relevant medical school in Rio de Janeiro, Brazil, were selected through preliminary interviews with medical students. The professors were subjected to open-ended interviews. The resulting material was interpreted through a conceptual framework derived from Ludwik Fleck, in order to establish the relevant elements of the thought style characteristic of the way they select and acquire new knowledge. The thought style that emerged from this set of interviews can be briefly characterized as a largely intuitive, pragmatic, result-oriented search of relevant (that is, potentially useful in practice) information. The doctors sought sources with academic credibility, but they maintained primary interest in practical, experiential knowledge. They also expressed a rather sceptical stance, at times bordering on cynicism. Despite this mistrust, doctors lack the resources (time, knowledge of technical aspects of research, particularly in terms of epidemiology and statistics) to effectively assess knowledge that is constantly being force-fed to them. This relative lack of resources is worsened, on one side, by the perception of medicine as subject to frequent and major changes, and on the other by the vastly disproportionate forces available to those who effectively produce and distribute such knowledge.

Key Words: epistemology • medical anthropology • medical knowledge • thought style

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