Clinical reasoning and generics

Rajeev R. Dutta
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Abstract

I argue that generic generalizations expressed in language (i.e. ‘generics’) are apt for clinical reasoning. I introduce generics and describe two problems in the use and interpretation of generics: Generics may license inaccurate judgements about the frequency of events or properties within a group (i.e. a problem with the ‘truth-aptness’ of generics) and may facilitate problematic beliefs about social kinds (e.g. prejudice or essentializing). I provide an account of clinical reasoning and describe some features of what I call ‘good’ clinical reasoning. I offer examples of generics in clinical contexts and examine how the two problems with generics (i.e. of truth-aptness and social generics) can harm patients and impair clinical reasoning. However, I ultimately argue that generics are important for good clinical reasoning because they track ‘conspicuous’ features of disease processes (e.g. severe possible outcomes). Further, I argue that prejudicial generics are often irrational to believe. Social generics that are rational to believe need not lead to problematic implicatures about social kinds and can instead facilitate meaningfully articulating societal injustices. I then argue that statistical statements, which are tempting alternatives to generics in clinical reasoning, are no better than generics for good clinical reasoning.
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临床推理和非专利药
我认为,用语言表达的一般概括(即 "类属")适合用于临床推理。我介绍了泛型,并描述了在使用和解释泛型时存在的两个问题:类属可能会导致对群体中事件或属性的频率做出不准确的判断(即类属的 "真-适切性 "问题),也可能会助长对社会类型的错误信念(如偏见或本质化)。我对临床推理进行了阐述,并描述了所谓 "好的 "临床推理的一些特征。我将举例说明临床推理中的类属推理,并探讨类属推理的两个问题(即真实性和社会性类属推理)是如何伤害患者和损害临床推理的。不过,我最终认为,属概念对良好的临床推理非常重要,因为它们能追踪疾病过程的 "明显 "特征(如严重的可能结果)。此外,我还认为,带有偏见的属概念往往是非理性的。理性相信的社会类属并不一定会导致对社会类型的有问题的暗示,反而会促进有意义地表达社会不公正。然后,我认为,在临床推理中,统计语句是诱人的泛型替代品,但对于良好的临床推理而言,统计语句并不比泛型更好。
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