This unique book is a major contribution to the literature on persuasion in communication, and on doctor-patient communication, in particular. Written by a physician-scientist with deep experience on the topic, the book offers a comprehensive analysis of what makes an argument in medicine persuasive, outlining the characteristics of an argument that causes people to accept that the conclusion(s) of an argument are true. Although the book focuses on medical arguments in particular, the general approach offered by the author is appropriate for any informal argument. The central emphasis is that although sound logical construction and true premises are required to establish the logical truth of a conclusion, this is insufficient for persuasion to occur. Although formal logic can exist independent of human reception, real-world arguments must have both an arguer (the individual constructing the argument) and an audience (individuals listening and evaluating the argument). Whether the audience is capable of changing their world view is as important as the logical construction of the argument, maintains the author. To illustrate all points, a plethora of examples in medical research and in diagnosis and treatment decisions are presented. Medical Persuasion: Understanding the Impact on Medical Argumentation is a unique contribution to the clinical literature and will be of immense interest to medical practitioners, researchers, and philosophers as a way of gaining insights into constructing arguments for their peers and patients. In addition, medical trainees will gain important insights in the production of medical knowledge and medical practices, and even students in the social sciences and humanities will find the work valuable as a conduit to gaining insight into the reception of an argument.
Author(s): Vic Velanovich
Publisher: Springer
Year: 2023
Language: English
Pages: 374
City: Cham
Preface
Contents
Chapter 1: Introduction
1.1 A Clinical Vignette
1.2 Persuasion Foundations of the Medical Encounter
1.3 Decision-Making Foundations in the Medical Encounter
1.4 Broadening the Concepts of Persuasion and Argument in Medicine
References
Chapter 2: Rationality, Reasoning, Logic, Argumentation and Intuition: The Bases of Medical Assessments and Decisions
2.1 Rationality and Reason
2.1.1 Rationality from a Philosophical Perspective
2.1.2 Rationality from an Economics Perspective
2.1.3 Rationality and Emotions
2.1.4 Summary of Rationality
2.2 Reasoning/Critical Thinking
2.3 Logic
2.4 Informal Logic and Argumentation
2.4.1 Arguments Versus Explanations
2.4.2 Arguments as a Method of Deriving New Truths
2.4.3 Arguments as a Method to Come to a Decision
2.4.4 Arguments to Persuade
2.5 Intuition in Medical Decisions
2.5.1 Intuition in Medicine
2.6 Conclusions
References
Chapter 3: The Human Mind: Relationship of Evolutionary Imperatives on Discerning Truth
3.1 A Brief Review of Primate Evolution to Anatomically Modern Humans
3.1.1 The Evolution of the Human Brain
3.1.2 Human Self Domestication/Emotional Plasticity
3.2 Social and Cultural Evolution Emphasizing Group Cohesion
3.2.1 The Social Brain
3.2.2 Other Minds
3.2.3 Evolution of the Cultural Framework
3.2.4 Are There Unconscious Influences on How Humans Receive Information?
3.3 The Idea of the Social Umwelt, or Although Seeing Is Believing, Sometimes We See What We Believe
3.3.1 Introducing the Concept of the Social Umwelt
3.3.2 Primal World Beliefs
3.3.3 Moral Foundations
3.3.4 Motivated Cognition
3.3.5 Self-Deception
3.3.6 Susceptibility to Logical Fallacy
3.3.7 Shibboleth Behavior
3.3.8 Human Reasoning Based on Mental Models
3.4 Is this the Basis of the Patient’s Comprehensive and Rationality?
3.5 Final Thoughts
3.6 Summary and Synthesis
References
Chapter 4: Persuasion in Medicine: How Medical Arguments Are Accepted
4.1 Introduction
4.1.1 Aristotle as a Foundational Understanding of Persuasion
4.2 The Modern Study of Persuasion
4.2.1 Persuasion in Popular Culture
4.2.2 Modern Academic Study of Persuasion
Social Judgment Theory
Elaboration Likelihood Model
Cognitive Dissonance Theory
Narrative Paradigm
4.3 General Types of Persuasion Methods
4.3.1 Coercion
4.3.2 Emotional (Affective)
4.3.3 Appeal to Authority
4.3.4 Argumentation (Cognitive)
4.4 The Neuroscience of Persuasion
4.5 Factors Involved in Persuasion
4.5.1 The Social Union
4.5.2 Emotionality
4.5.3 Mimicry
4.5.4 Voice Modulation
4.5.5 Body Language
4.5.6 Resistance to Persuasion (Reactance)
4.5.7 Ambiguity of Words or Phrases
4.5.8 Memories in Persuasion
4.5.9 Self-Persuasion
4.5.10 Storytelling as an Instrument of Persuasion
4.6 Persuasion as Manifest Rationality
4.7 Effects of Patient Beliefs and Motivations on Persuasion
4.7.1 Health Care Communication
4.7.2 Patient Motivations
4.8 Persuasion of Other Medical Professionals
4.9 Summary
References
Chapter 5: Causation Attribution in Clinical Medicine
5.1 Introduction
5.2 Causal Attribution in the Common Experience
5.3 Philosophical Approaches to Causation
5.3.1 Deterministic Causation
5.3.2 Counterfactual Causation Theory
5.3.3 Probabilistic Causation
5.3.4 Causation as Agency (Interventionalism)
5.3.5 The Pluralism of Causation
5.3.6 Causation as a Constraint
5.3.7 Summary and a Practical View
5.4 Causation Attribution in Medicine: The Inter-Level and Inter-Field Nature of Medical and Biological Theories
5.4.1 Inter-Level Nature of Medical Theories
5.5 Medical Science and the Attribution of Cause (Integrating the Clinical Vignette)
5.5.1 Pitfalls in Causation Attribution: An Example of a Change in the Accepted Cause
5.5.2 Identifying a Cause as a Means of Predictability
5.5.3 Causation and the Reliability of Disease Diagnosis
5.5.4 Causation and the Reliability of Therapeutic Intervention
5.5.5 Extent of Deterministic in Medical Causation
5.5.6 Probabilistic Causation in Medical Theories
5.5.7 Integrating Mechanism with Deterministic Causation
5.5.8 Integrating Mechanism and Probabilistic Causation
5.5.9 Cause as a Target of Intervention
5.6 Causation in Explanation, Argument and Persuasion
5.6.1 Medical Attribution of Causation Is About Predictability
5.6.2 The Role of Causation in the Persuasion of Lay People and Professionals
Causation Used in Explanation
Causation as a Premises in an Argument
5.7 Summary
References
Chapter 6: Generation and Acceptance of New Medical Knowledge
6.1 Introduction
6.2 Basic Tenets of Epistemology
6.3 Medical Epistemology
6.4 Types of Medical Knowledge
6.4.1 Basic Science
6.4.2 Clinical Medicine
Knowledge of Diseases
Classification of Disease
6.4.3 Identification of New Diseases
The Function of the Case Report in Medical Epistemology
Acquired Immunodeficiency Syndrome/Human Immunodeficiency Virus
6.4.4 Practical Clinical Knowledge
Natural History
Etiology
Pathogenesis
Disease Incidence and Prevalence
Risk Factors
The Diagnostic Process
Therapeutic Intervention
Prevention of Disease
6.5 Medical Theories as a Starting Point for New Knowledge
6.6 How Gaps in Medical Knowledge Are Identified
6.7 Hypothesis Development
6.7.1 An Example of an Argument of the Hypothesis
6.8 Argument of the Experimental Protocol
6.8.1 Types of Studies
Observational
Ecological Study Design
Proportional Mortality Ratio Design
Case-Crossover Study Design
Cross-Sectional (Prevalence) Study Design
Case–Control Study Design
Cohorts
Interventional
Pre-Post Study Design
Nonrandomized Trial Study Design
Randomized, Controlled Trial Study Design
Cross-Over Randomized, Controlled Trial Study Design
Laboratory Study Designs
6.9 Types of Data
6.9.1 Choice of Outcome to Be Measured
6.9.2 Samples and Sample Representativeness
6.10 Statistical Analysis
6.11 The Argument of the Experimental Protocol
6.12 Argument of the Hypothesis’s Judgment
6.13 Data Interpretation in the Context of the Strength of Evidence
6.14 How Medical Research Is Peer-Reviewed
6.15 Knowledge Derived from the Practice of Medicine
6.15.1 Understanding and Wisdom
6.16 Acceptance of Medical Knowledge as a Form of Persuasion
6.16.1 In Relation to Healthcare Professionals
6.16.2 Patients and the Lay Public
6.17 Summary and Conclusions
References
Chapter 7: Adoption into Clinical Medicine and Application of Medical Knowledge to Patient Care
7.1 Introduction
7.2 Proposed Methods of Reasoning by Healthcare Professionals
7.3 How a Physician Determines Which Diagnostic Tests or Treatments Should Be Incorporated into Medical Practice
7.3.1 Conceptualization of Disease
7.3.2 Initial Foundation of a Physician’s Medical Knowledge
Evidence and Evidence-Based Medicine
Evidence from Observational or Randomized Controlled Studies
Systematic Reviews/Meta-analyses
Systematic Reviews vs. Narrative Reviews
Evidence-Based Medicine and the Duhem-Quine Problem
Evidence-Based Medicine and Tacit Knowledge/Clinical Epidemiology
7.3.3 Phronesis and Medical Practice
Physician’s Need to Evaluate Evidence and Act Despite Uncertainty
7.4 How a Physician Determines Which Diagnostic Tests or Treatments Would Be Appropriate for an Individual Patient
7.4.1 Medical Diagnostic Reasoning
7.4.2 How Physicians Learn About Disease Presentation
An Example of Textbook Description of a Disease Presentation
7.4.3 Diagnosis as a Matter of Semiotics of Signs and Symptoms
7.4.4 The Patient’s Presentation as a Story or Script
This History of Present Illness as Clinical Story-Telling
7.4.5 Information Through Objective Testing
Sensitivity, Specificity, Positive Predictive Value, Negative Predictive Value, Accuracy
Bayesian Probabilities
Objective Test Development
Example: The Development of the 24-h pH Monitoring for Pathologic Esophageal Acid Reflux
Caveat: Definitions of “Normal” and “Abnormal”
7.4.6 The Diagnostic Task
7.4.7 Formal Logical Diagnostic Reasoning Theories
Interpretation of Medical/Patient “Texts” as a Hermeneutical Process
Language and Communication
7.4.8 The Process of Placement of a Patient into a Diagnostic Category
7.5 Application of Medical Knowledge in Treatment Choices
7.5.1 Operative Decisions
7.5.2 Tension Between “Precision Medicine” and “Evidence-Based Medicine”
7.5.3 Outside Pressures That May Affect Physician Decision-Making
7.6 Intuition in Clinical Practice
7.6.1 Practical Wisdom
Professional Wisdom
The Non-Routine, Complex, Ambiguous Decision
Intuition: The Counter-Argument
7.7 How a Patient Accepts a Physician’s Recommendations
7.8 Conclusions
References
Chapter 8: Correlations with “Non-Western” Medical Theory and Practice: Traditional Chinese Medicine, Traditional Indigenous Medicine, Faith Healing, and Homeopathy
8.1 Non-Western Medicine Has a Theoretical Foundation Too
8.2 Traditional Chinese Medicine
8.2.1 Brief History of Traditional Chinese Medicine
8.2.2 Theoretical Foundation of Normal Human Functioning
8.2.3 Concept of “Disease”
What Is a “Disease” in Traditional Chinese Medicine?
Causal Attribution of Diseases
Theoretical Foundation of Diagnosis and Diagnostics
Theoretical Foundation of Treatments
8.2.4 Traditional Chinese Medicine, the Illative Core of Argumentation and Persuasion
8.3 Defining Traditional Indigenous Medicine
8.4 Traditional North American Indigenous Medicine
8.4.1 Traditional Indigenous Medicine within Nature
Wellness and Disease
Types of Indigenous Medical Practice
Ceremony
The Red Path (Road)
Pow-Wow
Drum and Drumming
Smudging
The Sweat Lodge
Herbal Medications
The Medicine Wheel
8.4.2 Traditional North American Indigenous Medicine, the Illative Core of Argumentation and Persuasion
8.5 Traditional African Medicine
8.5.1 African Culture and African Medicine
Theoretical Foundation of Traditional African Medicine
8.5.2 African Medical Practices
Types of Traditional African Medical Practitioners
Education and Training of Traditional African Medical Practitioners
8.5.3 Traditional African Medical Practices
Herbalists and Herbal Remedies
8.5.4 Traditional African Indigenous Medicine, the Illative Core of Argumentation and Persuasion
8.6 American Faith Healing
8.7 Alternative/Complementary Medicine: Homeopathy
8.7.1 Theory of Homeopathy
8.7.2 Practice of Homeopathy
Types of Physicians and Training
Typical Diagnoses Treated
Medication Preparation and Regulation
8.7.3 Homeopathy, the Illative Core of Argumentation and Persuasion
8.8 Conclusions
References
Chapter 9: Quantitative Calculation in Medical Decision-Making and Human Persuasion: Decision Sciences, Big Data, Computer Decision Aids, Medical Calculators, and Artificial Intelligence
9.1 Introduction: Medical Information Is Expanding and Changing
9.1.1 Growth of Medical Information
The “Beethoven String Quartet” Dilemma
9.2 Decision Sciences in Medicine
9.2.1 What is Decision Science?
9.2.2 Quantification of the Consequences of Medical Decisions
9.3 Decision Analysis
9.3.1 Basic Decision Tree
Values, Preferences and Utilities
Quality-Adjusted Life Years
Frequency Determinations
Decision Tree Construction
Sensitivity Analysis
9.3.2 Markov Analysis
Monte Carlo Simulation
9.3.3 Difficulties and Impracticality of Decision Analysis
Multiple Objectives
Difficult to Implement Clinically
The Problem of Gradation in Outcome
9.3.4 Decision Analysis in Medical Persuasion
9.4 Big Data
9.4.1 What Is “Big Data”?
9.4.2 Big Data and Healthcare
The Data
Data Analytics
9.4.3 Strengths and Weaknesses of Big Data
9.4.4 Big Data and Persuasion
9.5 Patient Decision Aids and Physician Decision Support
9.5.1 Patient Decision Aids
Patients Decision Aids and Persuasion
9.5.2 Decision Support Systems for Physicians
9.5.3 Risk Calculators
9.6 Artificial Intelligence and Applications to Healthcare
9.6.1 What Is Artificial Intelligence?
Categories of Artificial Intelligence
Types of Artificial Intelligence
9.6.2 Machine Learning Programs/Tools
9.6.3 Artificial Intelligence-Possible Clinical Applications
Predictions
Diagnostic Dilemmas
Rare Diseases
An Example of Early Sepsis Identification
Image-Based Diagnosis
9.6.4 Artificial Intelligence-Possible Research Applications
Hypothesis Generation
Drug Development
9.6.5 Limitations of Artificial Intelligence
The Black Box
Problems with Data and Implementation
9.6.6 Artificial Intelligence and Persuasion
9.7 Non-Human Based Decisions and Human Persuasion
9.7.1 Computers and Wisdom
9.7.2 Will Humans Be Persuaded by Computers?
9.7.3 The Beethoven String Quartet Dilemma Revisited
References
Epilogue: Can We Ever Get to a Normative Standard for Medical Discourse?
Glossary
Index
