From an epistemological perspective, the previous overview raises the question of what position medicine occupies in this scientific structure. From a historical perspective, two approaches currently dominate:
However, both models can only depict partial aspects, which will be analysed in more detail.
Kuhn's theory of science was also received within medicine. From this point of view, several development phases can be identified over the last two centuries in which evolutionary insights have led to profound paradigmatic changes in medicine. These include
In the 1990s, for example, high-ranking representatives of EBM argued that this development had created "a new paradigm for the practice of medicine", which has dominated clinical research ever since.
In the 20th century, it was above all scientific knowledge about mechanisation that shaped the development of society.
In the course of this development, scientific findings have also superseded all other scientific approaches in medicine with their findings on secondary tracks. The result was a one-sided view and interpretation of useful research for medicine from a purely scientific and technical perspective.
Applied to medicine, three guiding principles can be formulated as hypotheses for the scientific understanding of medicine. These reflect the development of the last 100 years and have established themselves as the dominant paradigmatic view:
The development of such a scientific perspective is no coincidence. It followed a centuries-long tradition that ran in waves and significantly characterised the scientific style of thinking in medicine over several milestones. The main achievements were
The extent to which this development - regardless of the progress made - can comprehensively capture and represent medicine and its practical activities will be analysed below.
Modern Western medicine, with its roots in the theoretical and practical natural sciences, is directly dependent on research findings from the basic sciences of physics, biology and chemistry.
If medicine follows this approach, it wants to generalise in a similar way to the procedure for gaining knowledge in the natural sciences.
This refers both to insights into the functioning of the human and animal organism itself and to its diseases, including the factors that determine diagnosis and treatment options in general. Individual people and animals with their individual disease processes are not included in this way of thinking
Presentations of individual cases and case histories, so-called clinical case seminars, only belong to scientific knowledge in the sense that they are representative and generalisable or are at least based on the possibility of drawing analogous conclusions on the basis of a case history that formulate further research questions. However, the individual aspects of the case are not relevant from this perspective.
In fact, however, medicine refers not only to the scientific knowledge of natural conditions and processes in the living organism, but also to the principles of action, the clinical methods that can be derived from them and their effectiveness research for use in individual cases.
In this way, it conceptually goes far beyond the interrelationships that can be determined using scientific methods.
Instead of the question "What is?" or "What is how?", the questions "What is to be done?", "What do we do first?" and "Why?" are asked in everyday clinical practice. Such practical questions cannot be answered in a sufficiently concrete way, neither by science nor by the humanities.
The scientific orientation of an approach practised in this way is not to make statements "about the nature of the world", but to create "a reasoned action in the world".
From this epistemological point of view, medicine can be defined alongside law, social sciences, economics and, in some areas of engineering, primarily as a practical science of action.
This view was developed and advocated in relation to medicine in particular by the German philosopher and doctor Wolfgang Wieland (1933-2015). He refers to the writings of Richard Koch (1882-1949), who advocated a similar approach as early as 1917. Both of these representatives of medical scientific thought are philosophically based on the science of Aristotle (384-322 BC), for whom medicine was a techné (ancient Greek for craft, art, skill). (Wieland, 2014)
Such a definition elevates human action itself to the status of science and no longer makes a clear distinction between knowledge-generating research and practical application, which is based more on skills and understanding.
In everyday clinical practice, a separation between theoretical and practical areas is not as convincing as in the engineering sciences, for example, since medical practice is not concerned with the development of universally valid procedural techniques, but always with the clinical aspects of diagnosis, therapy and prevention of individual clinical pictures in general and their meaningful applications in individual cases.
In addition, the spectrum of a scientific approach is considerably broadened by the practical skills and ethical attitude of the practitioners in their actions - in direct application to patients. It is precisely this concrete, primarily practical orientation that shapes everyday clinical practice in medicine.
The real focus of medicine points to another focus. Irrespective of any theorem - even in terms of historical understanding - medicine has always been characterised by craftsmanship:
It is easy to see that medical action is a service to the patient, above all based on the philosophy and ethics of acting for people and animals.
In practice, it is therefore not enough to limit oneself solely to theoretical and practical scientific and humanities-based findings or statistically proven guidelines for action.
Theoretical findings and the results of individual scientific and sociological research cannot be transferred 1:1 to the complexity of lifeworlds and certainly not to that of an individual life.
The human being as an individual also does not function as a partial fragment of individual basic scientific disciplines, but only as a whole in the totality of all living conditions (context) as a vulnerable individual.
Added to this is the situational compulsion to act in everyday practice: "Theory or not, what do we do with Mrs K. and Mr M. right now?". Completely independent of the current state of scientific or sociological knowledge, which as a rule often does not (yet) provide an answer to many questions or is conceptually unable or unwilling to do so, e.g. in existential questions.
Daily medical practice therefore has its own epistemological conditions, which are best described on the basis of real-world evidence[2] and an appropriate ethical stance.
Every day, there are an unmanageable number of individual cases with special features which, on closer inspection, do not comply with established guidelines and their external evidence criteria. The age-old and well-known maxim "Diseases don't read textbooks" still applies in today's practice.
In the actual application on the patient, different, even contradictory and contradictory findings with unexpected reactions can arise in deviation from proven study results and SC guidelines and become the "individual truth" of the patient, which must be dealt with in everyday life.There are numerous examples of this on a daily basis, particularly in general medical practice with the less selected patients. This practical clinical orientation calls for ethical standards, without which there can be no responsible medicine.
Up to this point, the discussion has shown that medicine cannot be comprehensively and accurately categorised into any of the existing scientific categories.
A more general, open definition therefore describes medicine sui generis as Healing knowledge, which utilises all available scientific achievements, follows a scientifically based working method and is guided by ethical principles.
Every medical activity is a practical action on humans and animals based on complex issues and requires the interdisciplinary application of scientific knowledge from all available scientific fields. They characterise the way in which we work and give weight to the professional encounter between practitioner and patient.
A sole reduction to theoretical scientific findings and quantitative research (empirical analysis) fails in practice due to the complexity of the individual case, as does the emphasis on solely humanistic thinking - qualitative research[3] (sociology).
Medicine is not necessarily a science in itself, but rather practical healing knowledge. It applies scientific findings in the best possible way to the patient using methods that are as scientific as possible.
Ideally, medicine simultaneously promotes the acquisition of knowledge and the development of individual skills of all practitioners and is based on differentiated ethics.
[1] Cognitive bias is a psychological collective term for systematic, unconscious errors in perception, memory, thinking and judgement
[2] Real World Evidence (RWE)- Real evidence in medicine means evidence (= proof) from real data, which is clinically obtained observational data. These are not obtained from randomised controlled trials (RCTs), but are generated and tested from the analysis of routine clinical practice.
[3] Qualitative research describes sociological methods used to collect and analyze non-standardized data with the aim of gaining deeper insights into human behavior (to map and explore decision-making criteria, motivational patterns, and structures of action).
Authors: glt | Rev.: TBD | Ed.: pz | last modified May 21, 2025