How Doctors Think: Clinical Judgment and the Practice of Medicine
How Doctors Reckon: Clinical Judgment and the Do of Medicine Books
- ISBN13: 9780195187120
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- Notes: Brand New from Publisher. No Remainder Mark.
Product Description
How Doctors Reckon 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 do that relies on clinical reasoning. A physician looks at the patient’s history by the side of with the presenting corporal signs and symptoms and juxtaposes these with clinical experience and empirical studies to hypothesis a tentative account of the illness.
How Doctors Reckon is divided into four parts. Part one introduces the concept of medicine as a do rather than a science; part two discusses the thought of causation; part three delves into the administer of forming clinical judgment; and part four considers clinical judgment within the uncertain nature of medicine itself. In How Doctors Reckon, 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.
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After reading with disappointment Dr. Groopman’s identically titled work, I sought after Dr. Montgomery’s account to work, to ring right. Alas it does not. It would be more accurately titled “How Medical School Faulty Say They Reckon 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 do 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 trying 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 fantastic entertainment, but they really ought not to congratulate themselves. Understanding Pliny, Hume or Pound, one will not know very much the day-in, day-out do of medicine.
Rating: 3 / 5
There are two books with this same title, “How Doctors Reckon,” that have arrived at more or less the same time. Dr Groopman’s book will sell more copies, and is a helpful book for building competence for administration both sides of the doctor-patient interaction. This book is something different. It is a historic milestone that offers extraordinary help to those who are committed to guiding the medical professions in shifting their orientations and competences for the challenges facing them. It arrives at the aptly moment, in that to effectively address these challenges will require new understandings of what doctors are and do, how they become what they are and how they are trained to do what they do. I am grateful that Ms. Montgomery has published it.
Rating: 5 / 5
This is a fantastic book — it is much more advanced than Groopman’s book, and is probably aimed at a different audience. Groopman addresses the layperson, even as Montogomery addresses issues and thoughts that the average reader would have distress with. She is a fantastic novelist, though, and this is well worth your time.
Rating: 5 / 5
It is not so much,”How doctors reckon” as much as “How doctors DON’T reckon” as they are frightened to pieces of being sued. So they follow “algorithms” made by the “literati” in academia, who are also willing to testify hostile to them for a reasonable remuneration. This specter is enough to paralized the brains of most physicians in the full do of medecine. As one of my mentors proclaimed” If you do long enough, you are certain to be sued”. Hence, it is better to test than to reckon, so “thou shall be tested and billed for it”. What do you reckon?
Justiniani, retired neurologist.
Rating: 1 / 5
This is an fascinating book. The author, Kathryn Montgomery, isn’t a doctor, but rather a “Professor of Medical Humanities” (PhD in English literature). For whatever reasons, she report has it that developed a strong interest in understanding the do of medicine at both social and individual levels (“how doctors reckon”), 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 do, so 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 even as medicine necessarily makes use of science and technology, medicine is NOT itself a science (an argument hostile to doctors wearing white coats!), but rather an applied do with humanistic aims, ordinarily 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 ordinarily conducted in the midst of profound and unavoidable uncertainty, so judgment and skill based on attentive experience is necessary in order to make excellent decisions, and simple generalizable rules will never be enough by themselves. In this vein, because of its pragmatic case-specific orientation, the reasoning used in medicine must be a kind of interpretive matter-of-fact 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. But, as I read further, her style and approach grew on me, to the top 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 undemanding presentation (eg, How Doctors Reckon by Jerome Groopman), Montgomery’s intellectually expansive approach does take some getting used to, but the adjustment is well rewarded.
I highly urge this book to anyone interested in understanding “how doctors reckon,” provided they’re not deterred by a honestly 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 matter-of-fact, since we all need to work with doctors, sometimes in dire circumstances. I also urge this book to doctors themselves, since much of what Montgomery reveals won’t be evident to many doctors, plus doctors may find it generally edifying to take some time to reflect on the fundamental nature of their profession.
Rating: 5 / 5