Epistemology

Epistemology is the study of the nature and scope of knowledge. How do we know what we know? What constitutes a reliable source of information?

We learn/know things through many means:

• Factual information
• Observations (empirical knowledge)
• Experience (phenomenology)
• Teaching by others, be they family, mentors, teachers, groups to which we belong
  • Experts, such as healthcare providers, certainly have an impact
  • So do TV’s (“Ask your doctor about…”
• Culturally based knowledge
  • Examples in health care include culturally-based health beliefs such as hikikomori, suudo, imbalances related to empacho, and fan death
• Instinct, intuition
• Learning through a faith tradition
• Narratives (teaching through story)
• Inspiration
• Serendipity (things unfold in an unexpected pattern that leads to understanding) or its opposite, zemblanity
• Collective consciousness (some postulate morphogenetic fields where learning is shared at a level beyond the physical realm)
• Contemplation
• Faith

The challenge is that in any encounter, two different people will have different knowledge, and different beliefs stemming from it. Take the following example, which is not uncommon in a Western medical practice:

A physician sees child for a well-child visit. The parents are insistent that they want to follow a specific plan for vaccinating, because it was recommended in a book they read. Their physician tried to reassure them that medical research does not indicate a significant danger, but the parents refuse to follow through with vaccinations. Everyone leaves the visit angry – the parents because they feel their concerns were not respected, the physician because of a sense that the patient did not respect his/her medical knowledge and a sense that the child might be at higher risk for infection.

A number of health issues carry a lot of controversy, in part because of differences in how people have gathered information. Often, patients don’t care if their doctors have read all the latest randomized controlled trials; people can become very protective of their health beliefs. Some examples of other topics which can which can become the subject epistemological clashes include:

• “Paranormal” experiences. In many cultures or family groups, for instance, it is common to discuss ghosts/spirits, subtle energy, or ESP as a part of everyday life. Different people draw the line in different places for when this would be considered an indication of a mental illness.
• Unusual sensitivities. Many patients claim to have uncommonly intense sensitivities to medications or environmental chemicals, but most medical organizations do not recognize multiple chemical sensitivity as a ‘legitimate’ diagnosis
• Conditions not widely accepted by allopathic medicine. Examples include systemic Candida, type 2 hypothyroidism, food intolerances, and adrenal fatigue.

Even outside of the realm of spirituality, religion, or culture, belief systems can clash. How might a healthcare provider optimize their chances of successfully offering care in these circumstances? Here are some tips:

1. Clarify the beliefs involved. Healthcare providers should clarify patient beliefs, and they should also be clear on their own. Patients should be ask questions prefaced by, “What do you believe will happen if…” or “Tell me more about why you think…” Repeating back one’s understanding of the other person’s belief can be helpful, as can carrying the belief forward; that is, what happens to a person if what they believe is correct?

2. Focus on safety. Will a person’s beliefs put them in danger in some way? If a treatment/approach has little documented harm, will it be harmful to try? Will their approach delay potentially lifesaving standard medical treatment? Could it harm others? Trying a supplement before a medication is one issue, delaying life-saving care of a child so that other approaches with no proof of efficacy can be tried is another.

3. Keep it positive. Don’t proselytize, don’t argue, and don’t mock their beliefs, or you’ll get nowhere. Sometimes, it is helpful simply to tell them how things would ‘normally’ be done from your perspective. For instance, on would say “Allopathic medicine would normally do this…”

4. As a healthcare provider, don’t be afraid of the magic medical mantra, “I don’t know.” It is okay to do your homework after the visit and get back to them. Sometimes a delay will allow you to consider your response to the belief in greater detail, as well to do research.

5. Ask what the emotional context of the visit is for you. Are you feeling angry, nervous, sardonic, skeptical, trying to suppress laughter, feeling disdain? Why do you feel that way? If you are not feeling objective, you need to be aware of that. If what they are asking of you is inappropriate or makes you uncomfortable, be honest with them about that.