How Doctors Think: Clinical Judgment and the Practice of Medicine

Kathryn Montgomery, PhD

Review by Vincent J Felitti, MD, FACP

Summer 2007 - Volume 11 Number 3

Kathryn Montgomery, a Professor of Medical Humanities, has written a book about the way physicians think and how we came to think that way. Her book is an unusual combination of highly readable academic erudition with fascinating observations and insights. Its origins lie in a college course she once gave in the origins of scientific knowing, and the fact that a number of her advanced placement students sought letters of recommendation from her to medical school. Seeing her former students after their acceptance and entry to medical school, she quotes a pediatrician's description of first-year medical students as "looking like children who had been abused."1 But perhaps the nidus upon which this book crystallized was the diagnosis of breast cancer in her 28-year-old daughter. Professor Montgomery is on two medical school faculties where she has spent many years studying how physicians come to know what we know, do what we do, and think the way we think. "Misunderstanding the epistemology of medicine--how doctors know what they know--has damaging consequences for patients, for the profession of medicine, and for physicians themselves ... . The costs are great. It has lead to a harsh, often brutal, education, unnecessarily impersonal clinical practice, dissatisfied patients, and disheartened physicians."1:p6

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