Book and Media Reviews Section Editor: Harriet S. Meyer, MD, Contributing Editor, JAMA.
Kathryn Montgomery, PhD, has written a thoughtful and provocative book that challenges us to reconceptualize our assumptions about how physicians think in the clinical encounter, how physicians-in-training are taught, and how physicians and patients interact.
In the introductory chapter, Montgomery, who is professor of bioethics and medical humanities at Northwestern University, starts by stating that clinical medicine is not a science. Furthermore, she suggests that the widely held and unquestioned assumption that clinical medicine is a science and that it follows the scientific method leads to approaches to medical education that are too harsh and to clinical practice that is too impersonal and, as a result, unsatisfying to physicians and patients. Rather than considering clinical medicine a science, she proposes that it be conceptualized as a rational, science-using practice. She draws on Aristotle's phronesis—the flexible interpretive capacity that enables moral reasoners to determine the best action to take when knowledge depends on circumstances—to characterize physician thinking in the clinical encounter as interpretive practice (pp 4-5). In clinical medicine, this interpretive practice is displayed as clinical judgment, which enables physicians to combine scientific information, clinical skill, and collective experience with similar patients to make sense of the particulars of one patient's illness and to determine the best action to take to cure or alleviate it. She goes on to say that clinical judgment done well is the ideal of every physician's practice and the goal of medical education.
Moore DE. Clinical Judgment. JAMA. 2006;295(17):2079-2084. doi:10.1001/jama.295.17.2080