How Doctors Think: Clinical Judgment and the Practice of Medicine by Kathryn Montgomery (PDF)

Description

How Doctors Think defines 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 Think is 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. In How 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.

User’s Reviews

Editorial Reviews: Review “This is a book that will be read with pleasure by anyone interested in how medicine is done and it is a book that should be required reading for all students starting their clinical training.”–Journal of the Royal Society of Medicine”Montgomery has certainly written a piece that will stimulate people to think more deeply about medical and wider health professional practice. It is a text I will recommend to students and colleagues.”–PsycCRITIQUES About the Author Kathryn Montgomery is Professor of Medical Humanities and Bioethics and of Medicine, and Director, Medical Humanities and Bioethics Program, Northwestern University Feinberg School of Medicine.

Reviews from Amazon users which were colected at the time this book was published on the website:

⭐This is an interesting book. The author, Kathryn Montgomery, isn’t a doctor, but rather a “Professor of Medical Humanities” (PhD in English literature). For whatever reasons, she apparently developed a strong interest in understanding the practice of medicine at both social and individual levels (“how doctors think”), much like an ethnographer who becomes fascinated with a particular culture and strives for a deep and comprehensive understanding of it. Her interest in this area pays off, because she succeeds in discerning both the essence and nuances of medical practice, thereby penetrating far beyond the naive and harmfully misleading impressions and assumptions held by most patients, and even by many doctors themselves.Her main finding, which she repeats and elaborates throughout the book, is that while medicine necessarily makes use of science and technology, medicine is NOT itself a science (an argument against doctors wearing white coats!), but rather an applied practice with humanistic aims, usually directed toward the particular needs of one patient at a time, accounting for the unique (and thus anecdotal) narrative unfolding of each patient’s history. Because of variabilities among patients and general limitations in knowledge, clinical medicine is usually conducted in the midst of profound and unavoidable uncertainty, so judgment and skill based on attentive experience is necessary in order to make good decisions, and simple generalizable rules will never suffice by themselves. In this vein, because of its pragmatic case-specific orientation, the reasoning used in medicine must be a kind of interpretive practical reasoning (Aristotle’s “phronesis”) which is quite different from positivistic scientific reasoning.I initially found Montgomery’s writing style to be a bit verbose and her overall presentation to be too repetitive. However, as I read further, her style and approach grew on me, to the point where it became spellbinding and I was sad to see the book end. I came to realize that Montgomery’s study and writing are greatly enriched by her humanities background, and that’s what sets her apart. For readers expecting a more dryly straightforward presentation (eg,

⭐by Jerome Groopman), Montgomery’s intellectually expansive approach does take some getting used to, but the adjustment is well rewarded.I highly recommend this book to anyone interested in understanding “how doctors think,” provided they’re not deterred by a fairly sophisticated treatment which is pitched at least one notch higher than the average general reader. What you learn may be quite eye opening, not to mention very practical, since we all need to work with doctors, sometimes in dire circumstances. I also recommend this book to doctors themselves, since much of what Montgomery reveals won’t be obvious to many doctors, plus doctors may find it generally edifying to take some time to reflect on the fundamental nature of their profession.

⭐This is an incisive, and personal, analysis of how physicians think. It analyzes the foundations and processes behind physician’s decision making, and their relationship to the patient. It also looks at some of the myths that add to the illusions that physicians sometimes project, both to bolster their persona as well as to hide the uncertainty that is behind many of their decisions. The writer is not a physician, which serves to give the book greater credibility, and is illustrated by her own anxiety regarding her daughter’s cancer at an unusual age. As a physician, I found myself agreeing with most of her insights. Her analysis of the seating patterns and hierarchy in medical conferences is hilarious and accurate. Although she looked at a department of medicine, I think it holds true for mos specialties.This book is not an easy read, and it can be fairly slow going because of the academic vocabulary and the sometimes obscure references to philosophy, science and literature. But it is worth reading. If you have been a patient, you may gain insight into your physician’s decisions. If you are a physician, you may end up realizing you are not who you thought you were.

⭐After reading with disappointment Dr. Groopman’s identically titled work, I wanted Dr. Montgomery’s account to work, to ring true. Alas it does not. It would be more accurately titled “How Medical School Faulty Say They Think about Medicine, as Recounted to an English Literature Critic.”Dr. Montgomery has no experience working in clinical medicine. So far as her book shows, she has been unable to make effective, sustained contact with anyone who does. That is the fundamental limitation of the book.In her early chapters, Dr. Montgomery is cramped to say what the practice of medicine IS. If serious about her topic, she should have dumped this antiquarian prejudice and concentrated on what medical practitioners DO.The book will be a difficult read for anyone who does not share Dr. Montgomery’s acquaintance with classical and modern literature. For those who share it, the book may be great entertainment, but they really ought not to congratulate themselves. Understanding Pliny, Hume or Pound, one will not understand very much the day-in, day-out practice of medicine.

⭐An important book that tries to place narrative back at the center of clinical medicine. This text makes a prolonged argument that clinical medicine is not a science, nor an art, but a practice that uses science. Implementing these ideas will go a long way towards resetting the public’s conception of medicine’s potential and improve goals of care discussions at all phases of life.

⭐Dr. Montgomery’s book should be a must for anyone who recognizes that their body is not working right. Medicine involves a science but it also involves decision making and playing the hunches. How Doctors Think invites the reader in the manner in which decisions are arrived at and role we play in assisting physician in their decision making.We cannot be passive recipients of medical care. Dr. Montgomery tells us why.

⭐Since I had to diagnose my own illness four years ago, I have been very interested in the subject of this book, and have collected not only this book but many others. Kathryn Montgomery’s book is one of the best in my collection. Two other good books: “Every Patient Tells a Story” by Lisa Sanders, and “How Doctors Think” by Jerome Groopman.

⭐An excellent review of how we approach the cognitive aspects of medical practice. Medicine shares a method of applied expertice with many other disciplines.

⭐Exceptional

⭐A book worth reading if you’re a doctor, someone who works with doctors, or a patient. I found the book puts into words a lot of what I have thought about how I think as a doctor. It nicely picks apart the belief that being a doctor is an art and a science; but then, rather than suggesting we abandon our historic ways and methods, argues we should hold onto them (and promote them) as they are the basis of our practice and in fact reflect our ethical duty to patients.

⭐Very interesting book

⭐Die Komplexität und die Vielfalt der ganz unterschiedlichen Enflüsse über ärztliche Entscheidungsfindung wird hier kenntnisreich von einer Sozialwissenschaftlerin herausgearbeitet, die Ärztliche Arbeit über Jahre beobachtet und ärztliches Denken systematisierend darstellen konnte. Absolut lesenswert – und weitaus tiefer gehend als ein später publiziertes Buch mit gleichem Titel; dieses geschrieben von einem erfahrenen Arzt.

⭐

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