Perspect Biol Med. 2021;64(2):251-270. doi: 10.1353/pbm.2021.0019.
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.
明智的医疗行动取决于审慎的判断。在医学背景下，审慎的判断需要掌握问题的相关概括、细节及其相互作用。概括的过程源于科学知识和统计方法的推进和应用，这一过程是被充分理解的。但是，具体化——即梳理出病例中相关独特特征的过程——则是模糊的、被忽视的，甚至被轻视。医生必须花时间识别、仔细梳理并权衡病例中各种生物的、人际的、背景的、技术的和伦理的方面。这些细节不仅是做出有价值且可接受的医疗决策的基础，而且熟练地处理这些细节是医学智慧的一个关键特征。本文提出了一系列策略，旨在指导医生全面理解个体病例及其组成的细节，这一建议是基于丰富的临床和课堂经验、文献回顾，并通过与医学和人文学科的多个学科的同事进行咨询而得到充实的。
