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. (shrink)

"First published in this translation 1955; second edition (revised) 1974; reprinted with additional revisions 1987; reissued with new Further Reading 2003; reissued with new introduction 2007"--T.p. verso.

Suitable for students and scholars, this title challenges the assumption that skepticism, rather than established belief, lies at the heart of scientific discovery.

Recently adopted health care practices and policies describe themselves as “patient-centered care.” The meaning of the term, however, remains contested and obscure. This paper offers a typology of “patient-centered care” models that aims to contribute to greater clarity about, continuing discussion of, and further advances in patient-centered care. The paper imposes an original analytic framework on extensive material covering mostly US health care and health policy topics over several decades. It finds that four models of patient-centered care emphasize: patients versus (...) their parts; patients versus providers; patients/providers/states versus “the system”; and patients and providers as persons. Each type is distinguishable along three dimensions: epistemological orientations, practical accommodations, and policy tools. Based on this analysis, the paper recommends that four questions be asked of any proposal that claims to provide patient-centered care: Is this care a means to an end or an end in itself? Are patients here subjects or objects? Are patients here individuals or aggregates? How do we know what patients want and need? The typology reveals that models are neither entirely compatible nor entirely incompatible and may be usefully combined in certain practices and policies. In other instances, internal contradictions may jeopardize the realization of coherent patient-centered care. (shrink)

Scientism is a philosophy which purports to define what the world ‘really is’. It adopts what the philosopher Thomas Nagel called ‘an epistemological criterion of reality’, defining what is real as that which can be discovered by certain quite specific methods of investigation. As a consequence all features of experience not revealed by those methods are deemed ‘subjective’ in a way that suggests they are either not real, or lie beyond the scope of meaningful rational inquiry. This devalues capacities that (...) (we argue) are in fact essential components of good reasoning and virtuous practice. Ultimately, the implications of scientism for statements of value undermine value-judgements essential for science itself to have a sound basis. Scientism has implications, therefore, for ontology, epistemology and also for which claims we can assert as objective truths about the world. Adopting scientism as a world view will have consequences for reasoning and decision-making in clinical and other contexts. We analyse the implications of this approach and conclude that we need to reject scientism if we are to avoid stifling virtuous practice and to develop richer conceptions of human reasoning. (shrink)

Most clinicians take for granted a simple, reductionist understanding of medical knowledge that is at odds with how they actually practice medicine; routine medical decisions incorporate more complicated kinds of information than most standard accounts of medical reasoning suggest. A better understanding of the structure and function of knowledge in medicine can lead to practical improvements in clinical medicine. This understanding requires some familiarity with epistemology, the study of knowledge and its structure, in medicine. Michael Polanyi's theory of tacit knowing (...) is advanced as the basis for developing a more accurate understanding of medical knowledge. Tacit knowing, which explores the taken-for-granted background knowledge that underlies all human knowing, is explained in detail with a focus on its relevance for clinical medicine. The implications of recognizing tacit knowing in medicine and medical decisions are discussed. These include the ability to explain the importance of the clinical encounter in medical practice, mechanisms for analysing patient and doctor as persons, and the need for humility given the uncertainty that the tacit dimension injects into all medical decisions. This more robust medical epistemology allows clinicians to better articulate the nature and importance of patient-centred care, to avoid pitfalls inherent in reductionist approaches to medical knowledge, and to think more clearly about the relationships between medicine and health care at the individual and population levels. (shrink)

Chapter 1 Who this book is for and who it is not for1 There are already too many books offering solutions to the problems of the health service. ...

The Embodied Mind provides a unique, sophisticated treatment of the spontaneous and reflective dimension of human experience.

Understanding Computers and Cognition presents an important and controversial new approach to understanding what computers do and how their functioning is related to human language, thought, and action. While it is a book about computers, Understanding Computers and Cognition goes beyond the specific issues of what computers can or can't do. It is a broad-ranging discussion exploring the background of understanding in which the discourse about computers and technology takes place. Understanding Computers and Cognition is written for a wide audience, (...) not just those professionals involved in computer design or artificial intelligence. It represents an important contribution to the ongoing discussion about what it means to be a machine, and what it means to be human. Book jacket. (shrink)

The author exposes an alienating conception of rationality and its influence over modern liberal thought and practice, looking specifically at the rise in moral relativism and the development of the liberal democratic state.

I had intended this review not specifically as a criticism of Skinner's speculations regarding language, but rather as a more general critique of behaviorist (I would now prefer to say "empiricist") speculation as to the nature of higher mental processes. My reason for discussing Skinner's book in such detail was that it was the most careful and thoroughgoing presentation of such speculations, an evaluation that I feel is still accurate. Therefore, if the conclusions I attempted to substantiate in the review (...) are correct, as I believe they are, then Skinner's work can be regarded as, in effect, a reductio ad absurdum of behaviorist assumptions. My personal view is that it is a definite merit, not a defect, of Skinner's work that it can be used for this purpose, and it was for this reason that I tried to deal with it fairly exhaustively. I do not see how his proposals can be improved upon, aside from occasional details and oversights, within the framework of the general assumptions that he accepts. I do not, in other words, see any way in which his proposals can be substantially improved within the general framework of behaviorist or neobehaviorist, or, more generally, empiricist ideas that has dominated much of modern linguistics, psychology, and philosophy. The conclusion that I hoped to establish in the review, by discussing these speculations in their most explicit and detailed form, was that the general point of view was largely mythology, and that its widespread acceptance is not the result of empirical support, persuasive reasoning, or the absence of a plausible alternative. (shrink)

The traditional medical epistemology, resting on a biomedical paradigmatic monopoly, fails to display an adequate representation of medical knowledge. Clinical knowledge, including the complexities of human interaction, is not available for inquiry by means of biomedical approaches, and consequently is denied legitimacy within a scientific context. A gap results between medical research and clinical practice. Theories of knowledge, especially the concept of tacit knowing, seem suitable for description and discussion of clinical knowledge, commonly denoted the art of medicine. A metaposition (...) allows for inquiry of clinical knowledge, inviting an expansion of the traditional medical epistemology, provided that relevant criteria for scientific knowledge within this field are developed and applied. The consequences of such approaches are discussed. (shrink)