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How Doctors Think: Clinical Judgment and the Practice of Medicine

kathryn montgomery

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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.

246 pages, Hardcover

First published October 27,2005

This edition

Format
246 pages, Hardcover
Published
November 1, 2005 by Oxford University Press
ISBN
9780195187120
ASIN
0195187121
Language
English

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kathryn montgomery

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Rating(3.8 / 5.0, 14 votes)
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14 reviews All reviews
Profile Image for Kimberly .
pzxpcpapsdl
★ ★ ★ ★ ★
July 15,2025
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Finally, here is a book that any clinician can truly relate to.

Medicine has long been regarded as both a science (episteme) and an art or craft (techne). However, the author presents a bold claim that it is neither. Instead, the concept of phronesis comes into play. Phronesis is all about the practice of making pragmatic decisions and taking action in uncertain or incompletely understood situations, with the ultimate goal of reaching a desired outcome.

Clinical decision making and clinical judgment align perfectly with this idea. Clinicians, this book is a must-read. As you peruse its pages, you're bound to have a massive aha-erlebnis (a moment of sudden realization or enlightenment).

For patients, reading this book will provide you with a better understanding of your doctor's thought processes and decision-making. It offers valuable insights into the complex world of medicine.

Highly recommended for both clinicians and patients alike, this book has the potential to transform the way we view and approach medical practice.
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Profile Image for Kimberly .
ThreeLeggedFrog
★ ★ ★ ★ ★
July 15,2025
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Her fundamental argument is that the "art vs. science" construct of medicine is deeply confused and misleading.

Medicine's relationship to science is indeed complex. In fact, most clinical medicine is perhaps best understood as _phronesis_, which is the practical reasoning and problem-solving described by Aristotle.

I find this argument to be quite persuasive and well elaborated. She delves into the works of postmodern philosophers to a certain extent. However, I find myself more inclined towards cognitive psychological models of clinical phronesis rather than postmodernism.

She also advocates in parallel for a shared acknowledgment of the ineluctable uncertainty that characterizes medicine. This is an important perspective on an important topic. Nevertheless, I felt that it could have been developed a little better.

Overall, her work offers valuable insights into the nature of medicine and its relationship with science and other disciplines.
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Kurokami_Hina
★ ★ ★ ★ ★
July 15,2025
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I had anticipated more from this book in several aspects.

For instance, some of the chapters, such as the part on taking history and clinical judgment, were evidently logical despite their descriptions. However, when considering the number of pages in relation to the useful content, it seems overrated.

The book might have benefited from a more concise presentation to enhance its overall value.

Perhaps a reevaluation of the content and its organization could lead to a more engaging and informative read.

It is essential to ensure that the number of pages is justified by the quality and significance of the information provided.

This would enable readers to obtain the maximum benefit from their investment of time and resources in reading the book.

Overall, while there are some positive aspects to the book, there is also room for improvement in terms of its content and presentation.
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TRLS18
★ ★ ★ ★ ★
July 15,2025
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The title of the book is rather misleading. It would be better if it were named How Doctors Should Think instead of How Doctors Think. There is a substantial difference between the two. The latter focuses on the description of facts, that is, how clinical decisions are made in hospitals. On the other hand, the former is more philosophical, delving into how medical school curricula should be changed.


The writing style of the book is argumentative, filled with various arguments. However, I wish the book had been more narrative. I can understand that the author is very thoughtful. But still, more stories would have been better!


Despite all its defects, the book does have its own merits. Some of the highlights of the book include the take-home suggestions by the author, such as "Experience is the best teacher." and "Learn from others' mistakes." "Pattern your practice on that of your clinical elders." and "Question everything you are told and much of what you see." The author's suggestion of always keeping paradoxes in mind is very insightful. After all, clinical decisions are full of paradoxes.


"Those who possess this rational capacity or virtue in great measure are often regarded as wise. Yet, as the philosopher Charles Taylor has pointed out, rationality as a whole has come into ill repute precisely because contemporary Westerners have no standard except science for what is rational." The author's emphasis on the significance of practical reasoning in clinical decisions is the core of the book. This is truly inspiring, as most people, including myself, have been mentally trapped in the realm of science.

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JabaCsmHater
★ ★ ★ ★ ★
July 15,2025
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An excellent treatise on the art of knowing and mastering the anxiety of not knowing

This is an outstanding exploration into the art of dealing with the uncertainty and anxiety that comes with not knowing. It delves deep into how we can better understand and come to terms with this aspect of our knowledge acquisition.


An excellent review of how we approach the cognitive aspects of medical practice

Medicine, like many other disciplines, has its own set of challenges when it comes to the cognitive aspects of practice. This review provides valuable insights into how medical professionals navigate through the complex web of knowledge and decision-making. It highlights the importance of continuous learning and the ability to adapt to new information and situations.


Medicine shares a method of applied expertise with many other disciplines. This commonality allows for the exchange of ideas and best practices, which can lead to further advancements in all fields. By understanding the cognitive processes involved in medical practice, we can also gain a better understanding of how to approach similar challenges in other areas. Overall, this article offers a comprehensive and thought-provoking look at the art of knowing and the cognitive aspects of medical practice.
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Profile Image for Kimberly .
YannHawari
★ ★ ★ ★ ★
July 15,2025
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Fascinating read!

It approaches the medical world and its complex balancing act of constant trade-offs. Just like all of us will, one day, encounter situations that require difficult decisions.

The writing style is highly readable, and at times, it is even lyrical. It makes the reader engage in a practice of self-reflection.

I would wholeheartedly recommend this to anyone with an interest in diagnosis in medicine. It provides valuable insights into the challenges and intricacies of the medical field.

Whether you are a medical professional or simply someone curious about how doctors make decisions, this article offers a thought-provoking perspective.

It highlights the importance of considering multiple factors and making the best possible choices in the face of uncertainty.

Overall, it is a captivating read that will leave you with a deeper understanding of the medical world and its constant trade-offs.

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Profile Image for Kimberly .
TFMMH
★ ★ ★ ★ ★
July 15,2025
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The book under review has the occasional insightful comments that manage to catch the reader's attention.

However, it is largely filled with constructivist nonsense. The constructivist approach taken in the book seems to lack a solid foundation and often veers into the realm of the absurd.

It presents ideas that are not only difficult to understand but also seem to have little practical application.

The author's attempt to promote constructivism comes across as forced and unconvincing.

While it is important to explore different theories and perspectives, this book fails to do so in a meaningful and coherent way.

Overall, it is a disappointment and not a recommended read for those seeking valuable and reliable information.
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agabeeee
★ ★ ★ ★ ★
July 15,2025
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This piece is truly interesting, informative, and is told in a very engaging manner. It embodies all the qualities that nonfiction should possess.

It presents a wealth of knowledge in a way that keeps the reader hooked from start to finish. The information is presented clearly and concisely, making it easy for the reader to understand and absorb.

However, it must be noted that at times, the content can get a bit repetitive. But this is not a fatal flaw by any means.

Despite the occasional repetition, the overall quality of the piece remains high. It still manages to hold the reader's attention and convey its message effectively.

Overall, it is a great example of what nonfiction writing can and should be. It combines interesting facts with engaging storytelling to create a piece that is both enjoyable and educational.

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