Practical Wisdom Through Narratives as Told by Medical Students and Physicians

OBJECTIVE: Medicine, as both clinical and moral practice, is increasingly complex. As such, there is growing appreciation for the importance of practical wisdom (phronesis), a multidimensional capacity that clinicians develop as they navigate practice. Narrative serves as a mode by which clinical exemplars communicate wisdom and therefore provides a rich structure through which practical wisdom can be observed as manifest in lived experience. The purpose of this study was to analyze clinical phronesis narratives to uncover how participants understand practical wisdom through the real-life challenges of clinical encounters. METHODS: This article describes a qualitative study using structured interviews of 62 participants (40 medical students and 22 physicians). Phronesis narratives describe a particular clinical situation involving an ethically or professionally challenging patient case in which respondents thought practical wisdom was demonstrated. RESULTS: Narratives frequently identified practical wisdom as being needed in encounters involving patient advocacy, individualized patient care, and communication skills. Character traits associated with practical wisdom included empathy, patience, and emotional intelligence. Narratives most often revealed dimensions of practical wisdom such as person-centeredness, poise, or goal-directed decision making. Findings confirm the clinical relevance and multiple dimensions of practical wisdom in medicine "in vivo" that had previously been described theoretically "in vitro." Analysis also revealed that clinical medical students appear able to observe practical wisdom in their supervising physicians, highlighting the need for role-modeling by wise exemplars. CONCLUSIONS: The moral content of clinical medicine can be illuminated by rich narratives that can assist in the formation of wise clinicians. Based on the richness of moral content found in these phronesis narratives, the inclusion of narrative-based practices in medical education may help cultivate practical wisdom in medicine.