The multiple faces of practical wisdom in complex clinical practices: An empirical exploration

Rationale, aims, and objectives: In recent publications, attention has been drawn to the importance of practical wisdom in order to ensure good, individually attuned care in complex clinical practices. However, what remains insufficiently elucidated is how practical wisdom emerges in the workplace. This study aims to describe manifestations of practical wisdom in medical practices within a general hospital. It also seeks to clarify the interruptions that can be considered as triggers for the emergence of practical wisdom. Furthermore, we searched for figurations, which possibly elicit or constrain the emergence of practical wisdom. Methods: We used 10 thick descriptions of very distinct patient cases to carry out an explorative qualitative heuristic in-depth analysis. Results: These varied cases enabled us to describe diverse manifestations of practical wisdom; in addition, we were able to discern 10 different “interruptions” that triggered practical wisdom, and finally, we hypothesize that certain infrastructural figurations might facilitate the manifestation of practical wisdom. Conclusions: We found that practical wisdom frequently emerged in unexpected and diverse guises in these clinical practices, although the “interruptions” that we discovered did not automatically trigger practical wisdom. We have investigated the figurations mentioned only to a limited degree. More empirical research is needed to make the philosophical concept of practical wisdom better manageable for clinical practices and to gain better understanding of the figurations that elicit or obstruct its manifestation.