The problem of theory and practice in the medical profession1

Abstract

Scientific knowledge is a symbolic system consisting of hypotheses, models and theories generated by means of a paradigm-mediated interaction between a scientific community and a research domain. Such a knowledge generating paradigm consists of already existing theories, as well as methodological and ontological beliefs or assumptions. In this article it is argued that the meaning ascribed to the central concepts of medical science(such as patient, disease, causality and therapy) are fundamentally determined by the 19th century logical positivist scientific paradigm. The ontological and methodological implications of the postmodern natural sciences (e.g. quantum physics) have not been applied to medical science. The 19th century ‘natural science paradigm’ therefore acts as a metatheory for both medical science and medical practice. However, the theoretical knowledge system generated by medical science acts as the theory for the practice of scientific clinical medicine which therefore functions with the same understanding of the central concepts such as patient, disease and disease causality, therapy etc. The limitations of this paradigmatic monism are illustrated by an analysis of the medical and societal response to the AIDS epidemic and it is concluded that medical science and practice, because of the complexity o f its research and practice domain, must accept in principle the possibility of paradigmatic pluralism (as in the social sciences) or should attempt to develop a holistic paradigm that will cope more adequately with its fields of research and practice.