Fifty years ago, Alvin Feinstein published his seminal book Clinical Judgment1 in which he argued that medicine needs reliable clinical data, a sound taxonomy of disease, and attention to the nature of clinical reasoning. The years following saw the establishment of modern evidence-based medicine (EBM), whereby the best medical decisions about a current patient are made by applying rigorously established outcomes of previous patients.2 The key instrument in both of these perspectives is a taxonomy of disease in which similarities among patient conditions are reflected in patient assignment to similar disease classes.3 Courses of disease in previous patients with a particular diagnosis then serve as predictions for the disease course of a current patient with the same diagnosis. Interpatient variability within a disease class is unaccounted for with this approach and is not formally exploited for treatment decisions.
Barbour DL. Formal Idiographic Inference in Medicine. JAMA Otolaryngol Head Neck Surg. Published online April 12, 2018. doi:10.1001/jamaoto.2018.0254
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