Reviews Book

How Doctors Think: Clinical Judgment and the Practice of Medicine

BMJ 2006; 332 doi: (Published 20 April 2006) Cite this as: BMJ 2006;332:979
  1. Kevin Barraclough, general practitioner (
  1. Painswick, Gloucestershire

    Kathryn Montgomery is a professor of medical humanities at Northwestern University in the United States and a literary scholar by training. Her thesis is that doctors (and patients) misrep-resent medicine as an invariant, replicable science, and that this misunderstanding causes harm. It harms patients because they have unrealistic expectations of outcomes, and it harms doctors who are deluded into thinking that they should be operating scientifically and so become either “unnecessarily impersonal” or “disheartened.” Montgomery believes that medicine is best described not as a science but as “practical reasoning” or, in her terminology, “phronesis” (ouch!).

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    Kathryn Montgomery

    Oxford University Press, £23.99/$39.50, pp 208 ISBN 0 19 518712 1

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    She is a sympathetic and sometimes incisive observer of the practice of clinical judgment. And she writes movingly about her own personal experience when her daughter was diagnosed as having breast cancer at 28. Her prose, when she avoids neologisms, is lucid and easy to read.

    While overall I enjoyed her book, I felt, however, that Montgomery rather overstated her thesis. Doctors do not really think that medicine functions …

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