The Practice of Medicine

Two and half millennia of scientific discovery - including the advances of the last two and half decades - have not altered medicine's practical rationality. No matter how solid the science or how precise the technology that physicians use, clinical medicine remains an interpretive practice. Medicine's success relies on the physicians' capacity for clinical judgment. It is neither a science nor a technical skill (although it puts both to use) but the ability to work out how general rules - scientific principles, clinical guidelines - apply to one particular patient. This is - to use Aristotle's word - phronesis, or practical reasoning. It enables physicians to combine scientific information, clinical skills, and collective experience with similar patients to make sense of the particulars of one patient's illness and to determine the best action to take to cure or alleviate it.