Skilled know-how, virtuosity, and expertise in clinical practice

Abstract

The terms “skilled know-how,” “virtuosity,” and “expertise” all denote forms of technical mastery. Applied to medicine they refer to different aspects of medical expertise. Yet, what exactly is medical expertise? Is it a kind of cognition, or action, or a combination of both? Additionally, what aspects of clinical practice does technical expertise refer to? In this chapter technical expertise in clinical practice is analyzed in terms of three identified components: cognition, motoric action, and interpersonal relations. Furthermore, the three components of technical mastery are related to Aristotle’s concept of practical wisdom, or phronesis. In his Nicomachean Ethics, Aristotle differentiated between two different forms of human action: techné and phronesis. In broad terms techné refers to an action that results in the production of external objects, while phronesis refers to an action that has its end in itself. This distinction provides the architectonic keystone of this analysis of expertise in clinical practice. This approach presents an alternative to the predominant cognitive conception of technical expertise in clinical practice. A full understanding of technical expertise, skilled know-how, and virtuosity is not possible without highlighting the important role of intentionality in action and other forms of pre-reflective knowing in clinical practice.