ABSTRACT:

Wise medical actions hinge on deliberative judgment. In the medical context, deliberation requires a grasp of a problem’s relevant generalizations, its particulars, and their interactions. The process of generalization, rooted in the advancement and application of scientific knowledge and statistical methods, is well understood. But particularization, the process of teasing out relevant unique features of a case, is obscure, neglected, or even trivialized. Physicians must take the time necessary to identify, carefully disentangle, and weigh the various biological, interpersonal, contextual, technical, and ethical facets of a case. Not only are such details fundamental to making worthwhile and acceptably achievable medical decisions, but a practiced dealing with these details is a key feature of wisdom in medicine. This essay proposes a set of strategies to guide physicians in achieving a thorough understanding of individual cases and their constituent particulars, a proposal informed by extensive experiences in the clinic and classroom and by a review of the literature, and enriched by consultations with colleagues from multiple disciplines in medicine and the humanities.

摘要：

明智的医疗行动取决于深思熟虑的判断。在医学背景下，审议需要掌握问题的相关概括、其细节以及它们之间的相互作用。概括的过程植根于科学知识和统计方法的进步和应用，是众所周知的。但具体化，梳理出一个案例的相关独特特征的过程，是模糊的、被忽视的，甚至是微不足道的。医生必须花必要的时间来识别、仔细理清和权衡病例的各种生物学、人际关系、背景、技术和伦理方面。这些细节不仅是做出有价值和可接受的医疗决定的基础，而且对这些细节的实践处理是医学智慧的一个关键特征。