When Care Thinks and Diagnosis Listens: A Medical and Pedagogical Epistemology of the Clinical Hypothesis. Illness as a Hermeneutic and Narrative Circle

This contribution offers a theoretical-pedagogical reflection on medical epistemology as an epistemic gaze that orients diagnosis, care, and professional education. Starting from the crisis of positivism in health care and from the plurality of paradigms (interpretive, critical-emancipatory, participatory, and post-critical), the article rehabilitates hypothetism: clinical knowledge advances through conjectures, trial and error, and the diagnosis takes shape as a hermeneutic site where signs, data, and biographical narratives are continuously tested and renegotiated. From this perspective follows a pedagogical proposal: to educate professionals capable of fallibilism, listening, and responsibility, and to recognise patients as coconstructors of meaning and decision-making. The aim is to shift illness from an object to be measured to a lived experience and a form of tacit knowledge, resisting the neoliberal reduction of care to performance and cost.