". It is with this discomfort that Kathryn Montgomery begins her book, How Doctors Think: Clinical Judgment and the Practice of Medicine. Why is it that it is so difficult to define clinical judgment, and why do we doctors squirm when we are forced to admit just how reliant we are on it?
The heart of the discomfort, Montgomery deduces, can be traced back to a fundamental “misdescription of medicine”. For doctors and the public, medicine is fundamentally a science: doctors have years of scientific training in medical school. Medical textbooks are factual tomes crammed with fine-print citations. Doctors read medical journals brimming with complex clinical trials. Doctors' opinions are a cut above those of a shaman or Aunt Ethel because they are backed up by science. Doctors wear white coats, just like scientists, and even call them lab coats.
But all these things are to some extent illusory. Montgomery states in print what we've had a sneaking suspicion about all along: medicine really isn't a science, in the true Newtonian sense. In the world of physical sciences there are absolute laws—of motion, of thermodynamics, of gravity; absolute laws from which deviance does not—cannot—exist. Medicine is almost the living antithesis of this. The biological variability of disease, human beings, and the human condition make such assured rationality almost laughable. Yes, there has been enough written about diabetes to sink a galleon, but there is no invariant law that will predict exactly what will transpire in my patient with his unique constellation of glucose control, pulmonary pathology, drug absorption, cultural expectations, financial constraints, and personality quirks."
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