Customer Reviews

How Doctors Think: Clinical Judgment and the Practice of Medicine

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K Montgomery's book is the culmination of many years of working with physicians trying to dissect their way of reaching a complex diagnosis. She has an exceptional hability to put in words what takes 20 years of medical practice. Her concept of medicine not as science but a progressive growth based on experience ( memory of previous encounters with thousands of patients) and...science + new developments is simply revolutionary. Practical reasoning is the essence of how doctors think in the practice of medicine!!!!! This is one of the best books I ever read. I recommend HIGHLY
Daniel Sette Camara, MD,FACP,FACG, FASGE

I was thrilled when I first began reading How Doctors Think, and my feelings did not change when I finally finished the last page of the book. In honest,lyrical prose, Kathryn Montgomery eloquently articulates the complicated tapestry of the clinical decision-making process physicians often encounter in the face of clinical uncertainties and probabilistic medicine. Kudos to a beautifully structured deconstruction of the culture of medicine and medical training! I highly recommend this book to those involved in medical education curricular development. For those who are already medical students, residents, fellows, and attending physicians, I would suggest this as a must-read book on your reading list.

The best overview of physician thought processes I have read. Well written;thorough; should help non-medical persons understand the challenges physicians face in the diagnostic process and is an excellent guide for physicians who wish to organize and improve there clinical judgment. An MD

This is an incisive, and personal, analysis of how physicians think. It analyzes the foundations and processes behind physician's decision making, and their relationship to the patient. It also looks at some of the myths that add to the illusions that physicians sometimes project, both to bolster their persona as well as to hide the uncertainty that is behind many of their decisions. The writer is not a physician, which serves to give the book greater credibility, and is illustrated by her own anxiety regarding her daughter's cancer at an unusual age. As a physician, I found myself agreeing with most of her insights. Her analysis of the seating patterns and hierarchy in medical conferences is hilarious and accurate. Although she looked at a department of medicine, I think it holds true for mos specialties.

This book is not an easy read, and it can be fairly slow going because of the academic vocabulary and the sometimes obscure references to philosophy, science and literature. But it is worth reading. If you have been a patient, you may gain insight into your physician's decisions. If you are a physician, you may end up realizing you are not who you thought you were.

This is an interesting book. The author, Kathryn Montgomery, isn't a doctor, but rather a "Professor of Medical Humanities" (PhD in English literature). For whatever reasons, she apparently developed a strong interest in understanding the practice of medicine at both social and individual levels ("how doctors think"), 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 practice, thereby 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 while medicine necessarily makes use of science and technology, medicine is NOT itself a science (an argument against doctors wearing white coats!), but rather an applied practice with humanistic aims, usually 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 usually conducted in the midst of profound and unavoidable uncertainty, so judgment and skill based on attentive experience is necessary in order to make good decisions, and simple generalizable rules will never suffice by themselves. In this vein, because of its pragmatic case-specific orientation, the reasoning used in medicine must be a kind of interpretive practical 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. However, as I read further, her style and approach grew on me, to the point 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 straightforward presentation (eg, How Doctors Think by Jerome Groopman), Montgomery's intellectually expansive approach does take some getting used to, but the adjustment is well rewarded.

I highly recommend this book to anyone interested in understanding "how doctors think," provided they're not deterred by a fairly 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 practical, since we all need to work with doctors, sometimes in dire circumstances. I also recommend this book to doctors themselves, since much of what Montgomery reveals won't be obvious to many doctors, plus doctors may find it generally edifying to take some time to reflect on the fundamental nature of their profession.

There are two books with this same title, "How Doctors Think," that have arrived at more or less the same time. Dr Groopman's book will sell more copies, and is a useful book for building competence for managing 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 right 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.

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, while Montogomery addresses issues and ideas that the average reader would have trouble with. She is a great writer, though, and this is well worth your time.

After reading with disappointment Dr. Groopman's identically titled work, I wanted Dr. Montgomery's account to work, to ring true. Alas it does not. It would be more accurately titled "How Medical School Faulty Say They Think 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 practice 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 difficult 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 great entertainment, but they really ought not to congratulate themselves. Understanding Pliny, Hume or Pound, one will not understand very much the day-in, day-out practice of medicine.

It is not so much,"How doctors think" as much as "How doctors DON'T think" as they are scared to pieces of being sued. So they follow "algorithms" created by the "literati" in academia, who are also willing to testify against them for a reasonable remuneration. This specter is enough to paralized the brains of most physicians in the full practice of medecine. As one of my mentors proclaimed" If you practice long enough, you are certain to be sued". Hence, it is better to test than to think, so "thou shall be tested and billed for it". What do you think?

Justiniani, retired neurologist.