Moral flux in primary care : the effect of complexity

Relational care and epistemic injustice

The philosophical underpinnings of primary care have been examined from several perspectives in recent years. In two previous articles, we have argued that a relational view of autonomy is better matched to the primary care setting than others, and that view is mainly formed from the descriptors of its practice. Here we develop that analysis further, linking it to other relevant theory: the experience of human suffering and epistemic injustice. We argue that relational care is fundamental to ameliorating epistemic injustice and that relationships are integral to ethical practice, rather than being distinct. We propose that personalised care as described in the NHS Long Term Plan is not possible without addressing epistemic injustice and therefore without reconsidering our existing normative ethical frameworks.

Finding meaning in the hidden curriculum - the use of the hermeneutic window in medical education

We have published a model of the GP consultation where biomedical and humanistic elements of the consultation are seen as complementary and where hermeneutics, the discovery and creation of meaning, plays an integral role in enriching the conversation between clinicians and patients. The relationship between teachers and learners shows strong parallels with the relationship between practitioners and patients. We therefore explore how a similar analysis can enhance the relationship between teachers and learners and propose that hermeneutics can be particularly powerful in exploring and making explicit elements of the hidden curriculum.

Appreciative assessment

In this article, we propose a new 'appreciative' attitude towards assessment, on two grounds. Firstly, in order to accommodate and benefit from diversity, in both medical practice and medical education; and secondly in order to promote critical thinking, self awareness and capability in trainees more generally. Appreciative assessment requires a dialogic approach - an approach which is already well established in the context of educational supervision, but which we argue is just as applicable to assessment.