Modern medicine is one of humankind's greatest achievements.Yet today, frequent medical errors and irreproducibility in biomedical research suggest that tremendous challenges beset it. Understanding these challenges and trying to remedy them have driven considerable and thoughtful critical analyses, but the apparent intransigence of these problems suggests a different perspective is needed. Now more than ever, when we see options and opportunities for healthcare expanding while resources are diminishing, it is extremely important that healthcare professionals practice medicine wisely. In Medical Reasoning, neurologist Erwin B. Montgomery, Jr. offers a new and vital perspective. He begins with the idea that the need for certainty in medical decision-making has been the primary driving force in medical reasoning. Doctors must routinely confront countless manifestations of symptoms, diseases, or behaviors in their patients. Therefore, either there are as many different "diseases" as there are patients or some economical set of principles and facts can be combined to explain each patient's disease. The response to this epistemic conundrum has driven medicine throughout history: the challenge is to discover principles and facts and then to develop means to apply them to each unique patient in a manner that provides certainty. This book studies the nature of medical decision making systematically and rigorously in both an analytic and historical context, addressing medicine's unique need for certainty in the face of the enormous variety of diseases and in the manifestations of the same disease in different patients. The book also examines how the social, legal, and economic circumstances in which medical decision-making occurs greatly influence the nature of medical reasoning. Medical Reasoning is essential for those at the intersection of healthcare and philosophy.
Table of Contents
Glossary of Concepts Preface 1. Introduction 2. What Are We to Make of Reasoning in Modern Medicine? 3. Epistemic Challenges and the Necessary Epistemic Responses 4. Medical Epistemology: The Issues 5. Deduction, Induction, and Abduction: The Basics 6. Evolution of Medical Reasoning 7. Variability versus Diversity in Variety-The Epistemic Conundrum and Responses 8. The Meaninglessness of the Mean 9. The Value of Statistical and Logical Thinking 10. The Centrality and Origins of Hypotheses 11. Necessary Presuppositions: The Metaphysics 12. The False Notion of Intention, Choice, and Inhibition 13. The Role of Metaphor 14. Dynamics 15. Medical Science versus Medical Technology 16. Irreproducibility in Biomedical Science 17. Medical Solipsism 18. Critique of Practical and Clinical Medical Reasoning 19. Calling to Be Better Than Ourselves