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1、HowDoctorsThink:ClinicalJudgmentandthePracticeofMedicineKathrynMontgomeryOXFORDUNIVERSITYPRESSHOWDOCTORSTHINKThispageintentionallyleftblankHOWDOCTORSTHINKCLINICALJUDGMENTANDTHEPRACTICEOFMEDICINE:KathrynMontgomery2006OxfordUniversityPress,Inc.,publishesworksthatfurth
2、erOxfordUniversity’sobjectiveofexcellenceinresearch,scholarship,andeducation.OxfordNewYorkAucklandCapeTownDaresSalaamHongKongKarachiKualaLumpurMadridMelbourneMexicoCityNairobiNewDelhiShanghaiTaipeiTorontoWithofficesinArgentinaAustriaBrazilChileCzechRepublicFranceGree
3、ceGuatemalaHungaryItalyJapanPolandPortugalSingaporeSouthKoreaSwitzerlandThailandTurkeyUkraineVietnamCopyright©2006byOxfordUniversityPress,Inc.PublishedbyOxfordUniversityPress,Inc.198MadisonAvenue,NewYork,NewYork10016www.oup.comOxfordisaregisteredtrademarkofOxfordUni
4、versityPressAllrightsreserved.Nopartofthispublicationmaybereproduced,storedinaretrievalsystem,ortransmitted,inanyformorbyanymeans,electronic,mechanical,photocopying,recording,orotherwise,withoutthepriorpermissionofOxfordUniversityPress.CIPdataavailablefromtheLibrary
5、ofCongressISBN-13978-0-19-518712-0ISBN0-19-518712-1135798642PrintedintheUnitedStatesofAmericaonacid-freepaperToAnne,Ellen,Eric,Will,Jesse,Paul,Sallyann,Megan,Samantha,Ben,Anna,Lisa,Aaron,Jacob,Elijah,Debra,Michael,Hunter,Hannah,Beth,andTom—forwhomI’mthankfulallyearr
6、ound.ThispageintentionallyleftblankACKNOWLEDGMENTS:Overthelastdecade,usefullycriticalaudienceshavecommentedonvari-ousargumentsinthisbook,andeditors—kindly,impatiently,orboth—havenudgedearlyversionsofseveralchaptersintoprint.Mygratitudetothemisacknowledgedinthenotest
7、oeach.HereIwanttorecordmoregeneral,comprehensivethanks.Becausemyideasabouttherelationofmedicinetosciencetookshapeduringanearlierstudyofnarrativeinclinicalteaching,research,andpatientcare,manyofmydebtsareoldones.EdmundPellegrinofirstsuggestedtomethataneducationinliter
8、aturemighthaveadvantagesforunderstandingmedicine.IremaingratefultotheNationalScienceFoun-dation,whichknewthatmedicineisnotasciencebutriske
