chapter  5
Expertise and Tacit Knowledge in Medicine
WithVimla L. Patel, José F. Arocha, David R. Kaufman
Pages 26

Observers of the medical profession have often commented on the tension between the art and science of medicine. The science of medicine is viewed as emerging from the “bench” in the laboratories. Indeed, clinical medicine is built on a foundation that draws on the biomedical sciences of anatomy, biochemistry, as well as physiology and applied sciences such as pathology, radiology, and medical physics. The art of medicine has been seen as “practice at the bedside.” In medical folklore, the bedside has become a metaphor for all patient care. The science of medicine in clinical practice sees the physician as correlating or applying principles in an axiomatic or deductive fashion to a patient’s symptoms, yielding a precise diagnostic solution. The artistic approach involves the use of intuition, experience, and holistic perceptions in making clinical judgments and in the delivery of humane care. Traditionally, the scientific dimension is viewed as the application of explicit knowledge, and the more intuitive artistic side

draws on tacit knowledge. Although there is some truth in this distinction, the actual boundaries are much harder to delineate. As research into the study of expert performance has demonstrated, there is considerable tacit knowledge that underlies scientific reasoning in medicine (Patel, Arocha, & Kaufman, 1994). Similarly, there is a wealth of inarticulate scientific knowledge that supports the seemingly intuitive judgment of the expert practitioner. The poem by Alexander Pope exemplifies this paradox, where art and science and the tacit and explicit are blurred in the service of some common underlying order. Although all may not yield to a collective good, the hope is that it will yield some common understanding.