COGNITIVE TOOLS IN A CLINICAL ENCOUNTER IN MEDICINE - SUPPORTING EMPATHY AND EXPERTISE IN DISTRIBUTED SYSTEMS

This paper examines how, in use, culturally-provided tools can be said to embody knowledge and distribute thinking. It focuses on the routin e procedures used by medical professionals to investigate patient comp laints and examines explicit and implicit contributions of these conve ntional procedures to distributed thinking in clinical encounters in m edicine. After characterizing these tools, examples of how the tools g uide and constrain medical problem solving are provided The tools supp ort the development and exercise of the routines characteristic of med ical expertise, while at the same time preserving the nonroutine, cont rolled deliberation necessary for sound and ethical medical care. The paper concludes with ways in which the tools' role in thinking can be promoted through medical education, particularly during students' earl y clinical exposure: (a) Organizing learning experiences that expose t he tools' meanings; (b) exploiting the benefits of small group work to promote collaborative and individual competencies in distributed syst ems-and (c) explicitly utilizing the products of thinking with these t ools to further the goals shared by participants in clinical encounter s.