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Research ArticleEthics Feature

Becoming a Phronimos: Evidence-Based Medicine, Clinical Decision Making, and the Role of Practical Wisdom in Primary Care

Lisa Cosgrove and Allen F. Shaughnessy
The Journal of the American Board of Family Medicine August 2023, 36 (4) 531-536; DOI: https://doi.org/10.3122/jabfm.2023.230034R1
Lisa Cosgrove
From the Department of Counseling and School Psychology, University of Massachusetts-Boston (LC); Department of Family Medicine, Tufts University School of Medicine, Boston, MA (AFS).
PhD,
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Allen F. Shaughnessy
From the Department of Counseling and School Psychology, University of Massachusetts-Boston (LC); Department of Family Medicine, Tufts University School of Medicine, Boston, MA (AFS).
PharmD, MMedEd
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References

  1. 1.↵
    1. Svenaeus F
    . Illness as unhomelike being-in-the-world: Heidegger and the phenomenology of medicine. Med Health Care Philos 2011;14:333–43.
    OpenUrlCrossRefPubMed
  2. 2.↵
    1. Eisikovits N,
    2. Feldman D
    . AI and phronesis. Moral Philos Polit 2022;9:181–99.
    OpenUrl
  3. 3.↵
    1. Ericsson KA
    . Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Acad Med 2004;79:S70–81.
    OpenUrlCrossRefPubMedWeb of Science
  4. 4.↵
    1. Shaughnessy AF,
    2. Slawson DC,
    3. Bennett JH
    . Becoming an information master: a guidebook to the medical information jungle. J Fam Pract 1994;39:11.
    OpenUrlPubMed
  5. 5.↵
    1. Miller WL,
    2. McDaniel RR,
    3. Crabtree BF,
    4. Stange KC
    . Practice jazz: understanding variation in family practices using complexity science. J Fam Pract 2001;50:872–8.
    OpenUrlPubMedWeb of Science
  6. 6.↵
    1. Sturmberg JP
    . Evidence-based medicine-Not a panacea for the problems of a complex adaptive world. J Eval Clin Pract 2019;25:706–16.
    OpenUrl
  7. 7.↵
    1. Shaughnessy AF,
    2. Slawson DC,
    3. Becker L
    . Clinical jazz: harmonizing clinical experience and evidence-based medicine. J Fam Pract 1998;47:425–8.
    OpenUrlPubMedWeb of Science
  8. 8.↵
    1. Fong K
    . The U.S. health care system isn’t built for primary care. Harvard Business Review [Internet]. 2021 Sep 28 [accessed 2022 Oct 4]; Available from: https://hbr.org/2021/09/the-u-s-health-care-system-isnt-built-for-primary-care.
  9. 9.↵
    1. Kale MS,
    2. Korenstein D
    . Overdiagnosis in primary care: framing the problem and finding solutions. BMJ 2018;362:k2820.
    OpenUrlAbstract/FREE Full Text
  10. 10.↵
    Too much medicine. The BMJ [Internet]. 2022 [accessed 2022 Oct 4]. Available from: https://www.bmj.com/too-much-medicine.
  11. 11.↵
    1. Housten AJ,
    2. Lowenstein LM,
    3. Hoffman A,
    4. et al
    . A review of the presentation of overdiagnosis in cancer screening patient decision aids. MDM Policy Pract 2019;4:2381468319881447.
    OpenUrl
  12. 12.↵
    1. Wolinsky H
    . Disease mongering and drug marketing. Does the pharmaceutical industry manufacture diseases as well as drugs? EMBO Rep 2005;6:612–4.
    OpenUrlFREE Full Text
  13. 13.↵
    Psychiatry and the shores of social construction: Sami Timimi, MD [Internet]. Psychiatric Times. 2022 [accessed 2022 Oct 4]. Available from: https://www.psychiatrictimes.com/view/psychiatry-social-construction-sami-timimi.
  14. 14.↵
    1. Lockerman LZ
    . Deductive, inductive, and abductive reasoning. If it quacks like a duck, then is it a duck? J Craniomandib Sleep Pract 2022;40:287–8.
    OpenUrl
  15. 15.↵
    1. Ebell MH,
    2. Shaughnessy A
    . Information mastery: integrating continuing medical education with the information needs of clinicians. J Contin Educ Health Prof 2003;23 Suppl 1:S53–62.
    OpenUrl
  16. 16.↵
    1. Davies L,
    2. Welch HG
    . Current thyroid cancer trends in the United States. JAMA Otolaryngol Head Neck Surg 2014;140:317–22.
    OpenUrl
  17. 17.↵
    1. Johansson M,
    2. Brodersen J,
    3. Gøtzsche PC,
    4. Jørgensen KJ
    . Screening for reducing morbidity and mortality in malignant melanoma. Cochrane Database Syst Rev 2019;6:CD012352.
    OpenUrl
  18. 18.↵
    1. Thombs BD,
    2. Saadat N,
    3. Riehm KE,
    4. et al
    . Consistency and sources of divergence in recommendations on screening with questionnaires for presently experienced health problems or symptoms: a comparison of recommendations from the Canadian Task Force on Preventive Health Care, UK National Screening Committee, and US Preventive Services Task Force. BMC Med 2017;15:150.
    OpenUrlCrossRefPubMed
  19. 19.↵
    1. Wittkampf KA,
    2. Naeije L,
    3. Schene AH,
    4. Huyser J,
    5. van Weert HC
    . Diagnostic accuracy of the mood module of the Patient Health Questionnaire: a systematic review. Gen Hosp Psychiatry 2007;29:388–95.
    OpenUrlCrossRefPubMedWeb of Science
  20. 20.↵
    1. Thombs BD,
    2. Arthurs E,
    3. El-Baalbaki G,
    4. Meijer A,
    5. Ziegelstein RC,
    6. Steele RJ
    . Risk of bias from inclusion of patients who already have diagnosis of or are undergoing treatment for depression in diagnostic accuracy studies of screening tools for depression: systematic review. BMJ 2011;343:d4825.
    OpenUrlAbstract/FREE Full Text
  21. 21.↵
    1. Gray JA,
    2. Patnick J,
    3. Blanks RG
    . Maximising benefit and minimising harm of screening. BMJ 2008;336:480–3.
    OpenUrlFREE Full Text
  22. 22.↵
    1. Cassel EJ
    . The nature of suffering and the goals of medicine. N Engl J Med 1982;306:639–45.
    OpenUrlCrossRefPubMedWeb of Science
  23. 23.↵
    1. Richter B,
    2. Hemmingsen B,
    3. Metzendorf MI,
    4. Takwoingi Y
    . Development of type 2 diabetes mellitus in people with intermediate hyperglycaemia. Cochrane Database Syst Rev [Rev 2018;10:CD012661 [accessed 2023 Mar 7] Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012661.pub2/full.
    OpenUrl
  24. 24.↵
    1. Lerner BH,
    2. Curtiss-Rowlands G
    . What constitutes evidence? Colorectal cancer screening and the U.S. Preventive Services Task Force. J Gen Intern Med 2022;37:2855–60.
    OpenUrl
  25. 25.↵
    1. Alper BS,
    2. Price A,
    3. van Zuuren EJ,
    4. et al
    . Consistency of recommendations for evaluation and management of hypertension. JAMA Netw Open 2019;2:e1915975.
    OpenUrl
  26. 26.↵
    1. Shaughnessy AF,
    2. Cosgrove L,
    3. Lexchin JR
    . The need to systematically evaluate clinical practice guidelines. J Am Board Fam Med 2016;29:644–8.
    OpenUrlAbstract/FREE Full Text
  27. 27.↵
    1. Moynihan R,
    2. Bero L,
    3. Hill S,
    4. et al
    . Pathways to independence: towards producing and using trustworthy evidence. BMJ 2019;367:l6576.
    OpenUrlFREE Full Text
  28. 28.↵
    1. Sismondo S
    . Epistemic corruption, the pharmaceutical industry, and the body of medical science. Front Res Metr Anal 2021;6:614013.
    OpenUrl
  29. 29.↵
    1. Spielmans GI,
    2. Parry PI
    . From evidence-based medicine to marketing-based medicine: evidence from internal industry documents. Bioethical Inquiry 2010;7:13–29.
    OpenUrlCrossRef
  30. 30.↵
    1. Pagano D,
    2. Home P,
    3. Irs A,
    4. et al
    . The path for medical associations to sponsor trustworthy guidelines: is it feasible? J R Soc Med 2022;115:252–6.
    OpenUrlCrossRefPubMed
  31. 31.↵
    1. Lexchin J,
    2. O'Donovan O
    . Prohibiting or “managing” conflict of interest? A review of policies and procedures in three European drug regulation agencies. Soc Sci Med 1982 2010;70:643–7.
    OpenUrlCrossRefPubMedWeb of Science
  32. 32.↵
    1. Stegenga J
    . Medical nihilism [Internet]. Oxford University Press; 2018 [accessed 2022 Oct 21]. Available from: https://doi.org/10.1093/oso/9780198747048.001.0001.
  33. 33.↵
    1. Barry HC,
    2. Cosgrove L,
    3. Slawson DC
    . Where clinical practice guidelines go wrong. Am Fam Physician 2022;105:350–2.
    OpenUrl
  34. 34.↵
    1. Shaughnessy AF,
    2. Vaswani A,
    3. Andrews BK,
    4. et al
    . Developing a clinician friendly tool to identify useful clinical practice guidelines: G-TRUST. Ann Fam Med 2017;15:413–8.
    OpenUrlAbstract/FREE Full Text
  35. 35.↵
    1. Chiarotti F,
    2. Viglione A,
    3. Giuliani A,
    4. Branchi I
    . Citalopram amplifies the influence of living conditions on mood in depressed patients enrolled in the STAR*D study. Transl Psychiatry 2017;7:e1066.
    OpenUrl
  36. 36.↵
    1. Pūras D
    . Right of everyone to the enjoyment of the highest attainable standard of physical and mental health. Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health [Internet]. United Nations; 2019 [accessed 2022 Oct 12]. Available from: https://documents-dds-ny.un.org/doc/UNDOC/GEN/G19/105/97/PDF/G1910597.pdf?OpenElement.
  37. 37.↵
    1. Pūras D
    . Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health [Internet]. United Nations; 2017 [accessed 2022 Oct 12]. Available from: https://documents-dds-ny.un.org/doc/UNDOC/GEN/G17/076/04/PDF/G1707604.pdf?OpenElement.
  38. 38.↵
    Health systems science-2nd edition [Internet]. [accessed 2023 Mar 7]. Available from: https://www.elsevier.com/books/health-systems-science/skochelak/978-0-323-69462-9.
  39. 39.↵
    1. Tobin-Tyler E,
    2. Teitelbaum J
    . Training the 21st-century health care team: maximizing interprofessional education through medical-legal partnership. Acad Med J Med 2016;91:761–5.
    OpenUrl
  40. 40.↵
    National Center for Medical-Legal Partnership [Internet]. Medical-legal partnership. 2022 [accessed 2022 Oct 12]. Available from: https://medical-legalpartnership.org/.
  41. 41.↵
    1. Girard VW,
    2. Cannon Y,
    3. Bhatnagar P,
    4. Coleman S
    . How medical-legal partnerships help address the social determinants of mental health. Arch Psychiatr Nurs 2021;35:123–6.
    OpenUrl
  42. 42.↵
    1. Matthew DB
    . Medical-legal partnerships and mental health: qualitative evidence that integrating legal services and health care improves family well-being [Internet]. Rochester, NY; 2017 [accessed 2022 Nov 29]. Available from: https://papers.ssrn.com/abstract=3279690.
  43. 43.↵
    1. Pettignano R,
    2. Bliss LR,
    3. Caley SB,
    4. McLaren S
    . Can access to a medical-legal partnership benefit patients with asthma who live in an urban community? J Health Care Poor Underserved 2013 May;24:706–17.
    OpenUrl
  44. 44.↵
    1. Beardon S,
    2. Woodhead C,
    3. Cooper S,
    4. Ingram E,
    5. Genn H,
    6. Raine R
    . International evidence on the impact of health-justice partnerships: a systematic scoping review. Public Health Rev 2021;42:1603976.
    OpenUrl
  45. 45.↵
    Best care at lower cost: the path to continuously learning health care in America [Internet]. Washington, D.C.: National Academies Press; 2013 [accessed 2023 Mar 7]. Available from: http://www.nap.edu/catalog/13444.
  46. 46.↵
    1. Pellegrino ED
    . Toward a reconstruction of medical morality. Am J Bioeth AJOB 2006;6:65–71.
    OpenUrl
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The Journal of the American Board of Family     Medicine: 36 (4)
The Journal of the American Board of Family Medicine
Vol. 36, Issue 4
July-August 2023
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Becoming a Phronimos: Evidence-Based Medicine, Clinical Decision Making, and the Role of Practical Wisdom in Primary Care
Lisa Cosgrove, Allen F. Shaughnessy
The Journal of the American Board of Family Medicine Aug 2023, 36 (4) 531-536; DOI: 10.3122/jabfm.2023.230034R1

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Becoming a Phronimos: Evidence-Based Medicine, Clinical Decision Making, and the Role of Practical Wisdom in Primary Care
Lisa Cosgrove, Allen F. Shaughnessy
The Journal of the American Board of Family Medicine Aug 2023, 36 (4) 531-536; DOI: 10.3122/jabfm.2023.230034R1
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  • Article
    • Abstract
    • Phronesis Helps Avoid the Medicalization of the Human Experience
    • Phronesis Counters the Rush Toward Medical Intervention
    • Phronesis Prompts Judicious Adherence to Guidelines
    • Phronesis Keeps the Examination Room from Being an Island
    • How to Be a Phronimos
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