Ontological deskilling
Clinical expertise and the changing disease object in precision medicine
Bibliographic Data
| ID | 21702681 |
|---|---|
| Authors | Anastasios E Germenis (0000-0002-3315-6947, University of Thessaly, corresponding author) |
| Year | 2026 |
| Publication date | 2026-07-08 |
| Peer Reviewed | Yes |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | Medicine Health Care and Philosophy (JOURNAL) |
| Journal identifiers | ISSN: 1386-7423 • E-ISSN: 1572-8633 |
| Publisher | Springer Science and Business Media LLC (PUBLISHER) |
| DOI | 10.1007/s11019-026-10377-9 |
| PMID | 42417954 |
| OpenAlex | W7167690818 |
| Language | EN |
| References cited | 76 |
Concerns about physician deskilling in AI-enabled medicine usually ask how automated systems substitute for, attenuate, or distort clinical capacities. This article argues that precision medicine introduces a distinct object-side problem. Its dominant classificatory operation is not simply finer nosological classification but stratification for action: patients are grouped and regrouped for treatment selection, risk allocation, surveillance, trial eligibility, and prediction. In doing so, precision medicine fragments established disease categories, connects conditions across former boundaries, temporalizes disease into trajectories and thresholds, and produces actionable risk states and algorithmic subgroups. If clinical expertise is acquired through relatively stable nosological categories, then preserved skills may become insufficient when those categories no longer organize the clinical object in the same way. I call this failure of fit ontological deskilling. The article distinguishes it from technological deskilling, diagnostic uncertainty, overdiagnosis, medicalization, plastic diagnostics, and ordinary adaptive-learning demands. Drawing on Canguilhem, Mol, phenomenological intentionality, and accounts of expertise, it argues that ontological deskilling changes the conditions of clinical judgment, uncertainty, and responsibility. The appropriate response is critical nosological awareness: the ability to use disease categories competently while recognizing their contingency, plurality of functions, and susceptibility to transformation
Deskilling · Disease · Ontology · Philosophy of biology · Philosophy of medicine · Precision medicine · Artificial Intelligence in Healthcare and Education · Machine Learning in Healthcare · Mental Health and Psychiatry
Phenomenology of Illness
The Virtues In Medical Practice
Causality
The misunderstood limits of folk science
Tolerating Uncertainty — The Next Medical Revolution?
Network medicine
ACMG recommendations for reporting of incidental findings in clinical exome and genome sequencing
Disorder as harmful dysfunction
Labor and Monopoly Capital
Uncertainty tolerance in healthcare
Who is afraid of black box algorithms? On the epistemological and ethical basis of trust in medical AI
Disease classification
Sorting Things Out
Beyond nosology? Molecular tumor boards, singularization, and the conflation of diagnosis and therapy
Precision and personalized medicine
Sorting out and navigating uncertainty in precision medicine
Health as a Theoretical Concept
The concepts of health and illness revisited
Plastic diagnostics
What is Wrong with Social Theory
The Body Multiple
Grounded Theory and Sensitizing Concepts
Genomic expertise in action
| Citation velocity | historical |
|---|---|
| Highly cited | No |