Regulating clinical practice: epistemological and cognitive perspectives.

This article analyzes the nature of clinical decision-making in order to clarify some of the impediments to the direct regulation of medical work. It develops the familiar idea of medicine as an art, showing that this includes the notion that each clinical case is unique, that clinical medical knowledge is unavoidably segmented, that clinicians commonly reason from exemplary cases, and that in this process the fine judgment of each practitioner is indispensable. Taken together this means that outside attempts to regulate medicine directly are doomed to fail. A more promising strategy would be to adopt forms of reflexive regulation which mobilize the self-regulatory capacities of medical professionals themselves.