The Hidden Labyrinth of the Clinical Examination

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And so the penny drops.

One reason why the Doctoral journey (please indulge the metaphor for now) is such a transformative experience is not so much that more and more knowledge is piled on top of what we already know, it is rather that what we know, or rather what we thought we knew is suddenly up for grabs. It is no longer what we thought it was. It is transformed. And so are we.

For Mike, a medic with years of experience and expertise, a particular view of what happens in the process of clinical examination was transformed. He finds that what he thought was going on is not what was happening at all.  A technical-rational process of objective examination, checking symptoms against a definitive list of underlying causes – is opened up as subjective, an opaque weighing up of hunches and inclinations against evaluative criteria that are never made explicit because they are never acknowledged.

It strikes me that the distinct ways of framing the clinical examination echoes an ongoing argument that has been waging throughout the social sciences for some time.

What counts as evidence and how to we evaluate our statements about the world? 

There are three basic positions on the issue of evaluative criteria: foundational, quasi-foundational and non-foundational

Foundationalists […] who contend that research is research,quantitative or qualitative. All research should conform to a set of shared criteria (e.g. internal, external validity, credibility, transferability, confirmablity, transparency, warrantability.

Quasi-foundationalists contend that a set of criteria, or guiding framework unique to qualitative research need to be developed.These criteria may include terms like reflexivity, theoretical grounding, iconic, paralogic, rhizomatic and voluptuous validity.

In contrast, non-foundationalists stress the importance of understanding, versus prediction. They conceptualize inquiry within a moral frame, implementing an ethic rooted in the concepts of care, love, and kindness

(Denzin, 2009: 42 – 43)


Denzin, N. K. (2009). The elephant in the living room: or extending the conversation about the politics of evidence. Qualitative research, (2), 139-160.