Diagnosis from the perspective of Ontology in Medical Practice: Coordinating multiple realities and promoting dialogue between patient and doctor

Tabuchi Aya
Volume 6 Issue 1 Pages 17-28
First Published: October 06, 2023
[in Japanese]



Diagnosis is crucial in medical practice, but doctors in some fields, such as Geriatric Palliative Care and critical care, face difficulty making a diagnosis. This paper examines the existing discourse on evidence-based medicine and narrative based medicine approaches, the prevailing means of diagnosis, including criticism of these in modern Japanese medicine. In particular, the concepts of evidence-based medicine and narrative based medicine make diagnosis difficult by premising an epistemological dichotomy between subject and object, with a prioritization of objective evidence. We explore the ontology in medical practice that Annemarie Mol has discussed as a way to overcome this; it entails regarding a diagnosis as one of the representations of multiple enacted realities. Given that, unlike in evidence-based medicine, diagnosis is not considered objective, physicians are not positioned as dominant over patients, thus fostering more egalitarian doctor-patient relationships. Moreover, focusing on reality may encourage dialogue about the best treatment for the patient because medical practices are not discussed in terms of patient’s and doctor’s personal interests.


Key words

Diagnosis, Ontology in medical practice, Dialogue between patient and doctor, Evidence-based medicine (EBM), Narrative based medicine (NBM)