Despite technological innovations, clinical expertise remains the cornerstone of psychiatry. A clinical expert does not only have general textbook knowledge, but is sensitive to what is demanded for the individual patient in a particular situation. A method that can do justice to the subjective and situation-specific nature of clinical expertise is ethnography. Effective deep brain stimulation (DBS) for obsessive-compulsive disorder (OCD) involves an interpretive, evaluative process of optimizing stimulation parameters, which makes it an interesting case to study clinical expertise. The aim of this study is to explore the role of clinical expertise through an ethnography of the particular case of DBS optimization in OCD. In line with the topic of the special issue this article is a part of, we will also use our findings to reflect on ethnography as a method to study complex phenomena like clinical expertise. This ethnography of DBS optimization is based on 18 months of participant observation and nine in-depth interviews with a team of expert clinicians who have been treating over 80 OCD patients since 2005. By repeatedly observing particular situations for an extended period of time, we found that there are recurrent patterns in the ways clinicians interact with patients. These patterns of clinical practice shape the possibilities clinicians have for making sense of DBS-induced changes in patients’ lived experience and behavior. Collective established patterns of clinical practice are dynamic and change under the influence of individual learning experiences in particular situations, opening up new possibilities and challenges. We conclude that patterns of clinical practice and particular situations are mutually constitutive. Ethnography is ideally suited to bring this relation into view thanks to its broad temporal scope and focus on the life-world. Based on our findings, we argue that clinical expertise not only implies skillful engagement with a concrete situation but also with the patterns of clinical practice that shape what is possible in this specific situation. Given this constraining and enabling role of practices, it is important to investigate them in order to find ways to improve diagnostic and therapeutic possibilities.

尽管技术不断创新，但临床专业知识仍然是精神病学的基石。临床专家不仅具有一般的教科书知识，而且对特定情况下个体患者的需求很敏感。一种可以公正对待临床专业知识的主观性和特定情况性质的方法是民族志。针对强迫症 (OCD) 的有效脑深部刺激 (DBS) 涉及优化刺激参数的解释、评估过程，这使其成为研究临床专业知识的有趣案例。本研究的目的是通过对 OCD 中 DBS 优化的特殊案例进行民族志研究来探索临床专业知识的作用。与本文所属的特刊主题一致，我们还将使用我们的发现来反思民族志，将其作为研究临床专业知识等复杂现象的方法。这种 DBS 优化的民族志基于 18 个月的参与观察和对专家临床医生团队的 9 次深入访谈，这些专家临床医生自 2005 年以来一直在治疗 80 多名强迫症患者。通过长时间反复观察特定情况，我们发现临床医生与患者互动的方式存在反复出现的模式。这些临床实践模式塑造了临床医生理解 DBS 引起的患者生活经历和行为变化的可能性。集体建立的临床实践模式是动态的，在特定情况下个人学习经验的影响下会发生变化，开辟了新的可能性和挑战。我们得出结论，临床实践的模式和特定情况是相互构成的。由于其广泛的时间范围和对生活世界的关注，民族志非常适合将这种关系纳入视野。根据我们的发现，我们认为临床专业知识不仅意味着熟练地参与具体情况，而且还意味着在这种特定情况下塑造可能的临床实践模式。鉴于实践的这种限制和促进作用，重要的是要对其进行调查，以找到提高诊断和治疗可能性的方法。根据我们的发现，我们认为临床专业知识不仅意味着熟练地参与具体情况，而且还意味着在这种特定情况下塑造可能的临床实践模式。鉴于实践的这种限制和促进作用，重要的是要对其进行调查，以找到提高诊断和治疗可能性的方法。根据我们的发现，我们认为临床专业知识不仅意味着熟练地参与具体情况，而且还意味着在这种特定情况下塑造可能的临床实践模式。鉴于实践的这种限制和促进作用，重要的是要对其进行调查，以找到提高诊断和治疗可能性的方法。