Open Access Open Access  Restricted Access Subscription Access

Epistemic friction, affect and learning to know patients well: setting new norms for medical education

Nancy Nyquist Potter


Medical education takes seriously the centrality of treating the person and not just the illness. This paper engages with previous work on epistemic and ethical challenges to person-centered care. The aim of the paper is to identify some missing components that medical education must focus on if it wants to inculcate proper epistemic, ethical and affective skills in treating patients well. The argument has four parts: after introducing the problem and providing a background for this paper, I explain the relationship between objectivity and trust. In section II, I inquire into the conditions under which trust in physicians and in the medical establishment can be fostered. I explain the everyday realities of social situatedness that, I argue, must be taken into consideration in order to foster the right kind of objectivity and trust in medical fields. Section III builds on the previous sections by addressing problems of silencing that are systematic and harmful, especially to people from marginalized and minority groups. I draw on Kristie Dotson’s work of testimonial quieting and testimonial smothering in this section and apply it to patients in order to show how important it is to good doctoring practices that physicians learn to develop skills and virtues that address the epistemic problems this essay identifies. Section IV develops the main positive argument. Drawing upon Medina’s account of epistemic vices and virtues that are socially situated and systemically reproduced, I show what a thick notion of epistemic and ethical responsibility would look like. In particular, I argue that physicians need to know how to engage with, rather than remain detached from, epistemic friction in their encounters with patients and that such engagement requires affective sensibilities as well as epistemic and ethical ones. Coming full circle, I return to the starting point of the relationship between objectivity and trustworthiness and argue that struggles to develop a thick notion of physician responsibility in oneself simultaneously is epistemic, ethical, affective, social and political.


Affect, closemindedness, epistemic arrogance, epistemic friction, epistemic injustice, epistemic laziness, epistemic resistance, epistemic violence, epistemology, medical education, objectivity, person-centered healthcare, social situatedness, testimonial

Full Text:



Cavel, H. (2014). Illness. London & New York: Routledge.

Scheman, N. (2011). Shifting Ground: Knowledge and Reality, Transgression and Trustworthiness. Oxford: Oxford University Press.

Van Baalen, S. & Boon, M. (2015). An epistemological shift: from evidence-based medicine to epistemological responsibility. Journal of Evaluation in Clinical Practice 21 (3) 433-439.

Gupta, M. (2014). Is Evidence-based Psychiatry Ethical? Oxford: Oxford University Press.

Loughlin, M., Bluhm, R., Fulkkler, J., Buetow, S., Borgenson, K., Lewis, B.R. & Kious, B.M. (2015). Diseases, patients and the epistemology of practice: mapping the borders of health, medicine and care. Journal of Evaluation in Clinical Practice 21 (3) 357-364.

Goldenberg, M. (2006). On evidence and evidence-based medicine: Lessons from the philosophy of science. Social Science & Medicine 62, 2621-2632.

Cohen, A.M., Stavri, P.Z. & Hersh, W.R. (2004). A categorization and analysis of the criticisms of Evidence-Based Medicine. International Journal of Medical Informatics 73 (1) 35-43.

Grasswick, H. (2014). Understanding Epistemic Normativity in Feminist Epistemology. In: The ethics of belief, pp. 216-243. Matheson, J. & Vitz, R. (eds.). Oxford: Oxford University Press.

Cudd, A. (2006). Analyzing Oppression. Oxford: Oxford University Press.

Young, I.M. (2011). Justice and the Politics of Difference. New Jersey: Princeton University Press.

Frye, M. (1983). Oppression. The Politics of Reality: Essays in Feminist Theory. Berkeley, CA: Crossing Press.

Fricker, M. (2007). Epistemic Injustice: Power and the Ethics of Knowing. Oxford: Oxford University Press.

Potter, N. (2002). How Can I Be Trusted? A Virtue Theory of Trustworthiness. New York and Oxford: Rowman-Littlefield.

Murdoch, I. (1970). The Sovereignty of Good. Abingdon,UK: Routledge.

Miles, A. & Asbridge, J.E. (2014). Modern healthcare: a technical giant, yet an ethical child? European Journal for Person Centered Healthcare 2 (2) 135-139.

Cassell, E. (1991). The Nature of Suffering and The Goals of Medicine. Oxford: Oxford University Press.

Kaltoft, M.K., Nielson, J.B., Eiring, Ø., Salkeld, G. & Dowie, J. (2015). Without a reconceptualisation of ‘evidence base’ evidence-based person-centred healthcare is an oxymoron. European Journal for Person Centered Healthcare 3 (4) 496-502.

Spelman, E.V. (1988). Inessential Woman: Problems of Exclusion in Feminist Thought. Boston, MA: Beacon Press.

Star, S.L. & Bowker, G.C. (2007). Enacting silence: Residual categories as a challenge for ethics, information systems, and communication. Ethics and Information Technology 9, 273-280.

Halpern, J. (2001). From Detached Concern to Empathy: Humanizing Medical Practice. Oxford: Oxford University Press.

Code, L. (1991). What Can She Know? Feminist Theory and the Construction of Knowledge. Ithaca, NY: Cornell University Press.

Wylie, A. (2003). Why standpoint matters. In: Science and Other Cultures: Issues in Philosophy of Science and Technology. Figueroa, R. & Harding, S. eds. New York: Routledge.

Mills, C. (2007). White ignorance. In: Race and the Episemology of Ignorance, pp. 11-38. Sullivan, S. & Tuana, N., eds. Albany, NY: SUNY Press.

Potter, N. (2016). The Virtue of Defiance and Psychiatric Engagement. Oxford: Oxford University Press.

Bevir, M. (1999). Foucault, Power, and Institutions. Political Studies 47 (2) 345-359.

Foucault, M. (1973). The Birth of the Clinic: An Archeology of Medical Perception. London: Tavistock.

Hornsby, J. (1995). Illocution and its significance. In: Foundations of Speech Act Theory, pp. 187-207. Tsohatzidis, S., ed. New York: Routledge.

Daukas, N. (2006). Epistemic trust and social location. Episteme: A Journal of Social Epistemology 3 (1-2) 109-124.

Grasswick, H. (2012). Knowing moral agents: Epistemic dependence and the moral realm. In: Out from the Shadows: Analytical Feminist Contributions to Traditional Philosophy. Crasnow, S. & Superson, A., eds. pp. 307-338. Oxford: Oxford University Press.

Kirkengen, A.L. & Thornquist, E. (2012). The lived body as a medical topic: an argument for an ethically informed epistemology. Journal of Evaluation in Clinical Practice 18, 1095-1101.

Johnson, J., Bottoroff, J., Brown, A., Grewal, S., Hilton, B.A. & Clarke, H. (2004). Othering and being othered in the context of health care services. Health Communication 16 (2) 253-271.

Dotson, K. (2011). Tracking epistemic violence, tracking practices of silencing. Hypatia 26 (2) 236-257.

Bergen, L. (2002). Testimony, epistemic difference, and privilege: How feminist epistemology can improve our understanding of the communication of knowledge. Social Epistemology 16 (3) 197-213.

Medina, J. (2013). Epistemologies of Resistance: Gender and Racial Oppression, Epistemic Injustice, and Resistant Imaginations. Oxford: Oxford University Press.

Alcoff, L. (2007). Epistemologies of ignorance: Three types. In: Race and the Epistemology of Ignorance, pp. 39-57. Sullivan, S. & Tuana, N, (eds). Albany, NY: SUNY Press.

Barr, D. (2008). Health Disparities in the United States: Social Class, Race, Ethnicity, and Health. Baltimore, MD: Johns Hopkins University Press.

Goldfrank L.R. & Knopp K.R. (2000). Racially and ethnically selective oligoanalgesia: Is this racism? Annals of Emergency Medicine 35, 79-82.

Thomas, L. (1992). Moral deference. Philosophical Forum 22 (1-3) 233-250.

Moya, P. (2012). ‘Racism is not intellectual’: Interracial friendship, multicultural literature, and decolonizing epistemologies. In: Decolonizing Epistemologies: Latina/o Theology and Philosophy. Isasi-Diaz, A.M. & Mendieta, E., eds. pp. 169-190. New York: Fordham University Press.

Vetlesen, A.J. (1994). Perception, empathy, and judgment: An inquiry into the preconditions of moral performance. University Park, Pennsylvania: Pennsylvania State University Press.

Potter, N. (2009). Mapping the Edges and the In-Between: A Critical Analysis of Borderline Personality Disorder. Oxford: Oxford University Press.

Hodges, S. & Wegner, D. (1997). Automatic and controlled empathy. In: Empathic Accuracy. Ickes, W. ed. pp. 312-339. New York: Guilford Press.

Code, L. (2008). Advocacy, Negotiation, and the Politics of Unknowing. Southern Journal of Philosophy 46 (S1) 32-51.

King, T. (2013). The Inconvenient Indian: The Curious Account of Native People in North America. Minneapolis: University of Minnesota Press.



  • There are currently no refbacks.