How Doctors Think: Clinical Judgment and the Practice of Medicine

How Doctors Think: Clinical Judgment and the Practice of Medicine

How Doctors Think: Clinical Judgment and the Practice of Medicine

How Doctors Think: Clinical Judgment and the Practice of Medicine


How Doctors Thinkdefines the nature and importance of clinical judgment. Although physicians make use of science, this book argues that medicine is not itself a science but rather an interpretive practice that relies on clinical reasoning. A physician looks at the patient's history along with the presenting physical signs and symptoms and juxtaposes these with clinical experience and empirical studies to construct a tentative account of the illness.
How Doctors Thinkis divided into four parts. Part one introduces the concept of medicine as a practice rather than a science; part two discusses the idea of causation; part three delves into the process of forming clinical judgment; and part four considers clinical judgment within the uncertain nature of medicine itself. InHow Doctors Think, Montgomery contends that assuming medicine is strictly a science can have adverse side effects, and suggests reducing these by recognizing the vital role of clinical judgment.


It does not do harm to the mystery to know a little about it.


THIS BOOK IS about clinical judgment: why it is essential to medical practice even in a highly scientific, technologized era, how it works in that practice, some of the odd ways it is taught, and the consequences of ignoring it in favor of the assumption that medicine is itself a science.

There is no question that medicine is scientific or that the benefits of biomedicine are enormous. Once doomed lives are now routinely saved, and the sense of human possibility has been profoundly altered. Yet medicine is not itself a science. Despite its reliance on a well-stocked fund of scientific knowledge and its use of technology, it is still a practice: the care of sick people and the prevention of disease. The recent emphasis on evidencebased medicine grounds that practice more firmly in clinical research and aims to refine and extend clinical judgment, but it will not alter the character of medicine or its rationality. Physicians draw on their diagnostic skills and clinical experience as well as scientific information and clinical research when they exercise clinical judgment. Bodies are regarded as rule-governed entities and diseases as invading forces or guerrillas biding their time. But neither is true. Patients with the same diagnosis can differ unpredictably, and maladies, even those firmly identified with bacteria or tumors or genetic mutations, are never quite things. Thus, although scientific and technological advances refine clinical problems and provide solutions, physicians still work in situations of inescapable uncertainty. New diseases like human immunodeficiency virus (HIV) or severe acute respiratory syndrome (SARS) are the extreme examples . . .

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