Enacted Phronesis in General Practitioners Study

Aristotle described five intellectual virtues; this thesis sought to understand one of them in detail - phronesis (practical wisdom). The thesis demonstrates why phronesis is a useful way of conceptualising professional knowledge in the field of medicine. Two of these intellectual virtues have become well embedded in medical education; episteme (scientific knowledge) and techne (technical skill), but phronesis has not. Sophia (philosophical wisdom) and nous (intellectual insight) are the remaining excellences in knowledge described in the Nicomachean Ethics.

A critical interpretive literature review was conducted, scoping the published literature on the topic of phronesis in medicine. Twelve themes were generated which related to the historic, present, and future applications of phronesis in medicine. The literature review identified a lack of empirical work on the characteristics of phronimoi (wisdom exemplars). This thesis worked within the paradigm of constructivism and adopted mixed method research techniques. Part one involved administering a wisdom questionnaire to a large group of family medicine practitioners (GPs) in the West Midlands (UK). From this group (N=211), outlier scoring doctors were invited to participate in biographic narrative interviews. 18 interviews were conducted which included 16 doctors who fulfilled the criterion for high levels of wisdom.

The transcripts were analysed using two methods. First, a biographic narrative interpretive method was used which enabled the generation of case summaries, like character statements, which charted the lived life and told story of the exemplar. Second, a corpus linguistic frequency analysis enabled a conceptual framework to be produced which facilitated comparison and contrast of the exemplar transcripts. This also reflected the expressed thought processes of the wisdom exemplars.

The thesis describes 34 constituent features of enacted phronesis in a population of family medicine practitioners. It identifies key areas (personal qualities, contexts, mental habits, knowledge of self and relational aspects) that inform practical action through wise deliberation. It has resulted in the creation of a new theory which seeks to describe phronesis through analogy, the Fish School theory. It makes explicit what is ordinarily tacit in relation to the process of phronesis. This work has the potential to impact professional practice and medical education policy. The work also relates the concept of phronesis to eudaimonia (flourishing) and demonstrates that wiser doctors are happier doctors