Comments on Pellegrino’s ‘Anatomy of Clinical Judgments’

Abstract

Dr. Pellegrino’s statement of the end of clinical judgment, and of the questions that need to be asked in the course of the physician’s execution of his task in making such judgments, appears to me unexceptionable. And it is of course both correct and important to distinguish between the concrete, timebound, practical and humane goal of clinical practice on the one hand and the more generalizing, temporally less pressing, theoretical and less personal context of scientific inquiry on the other. As a philosopher interested in the conceptual structure of science, however, who cherishes a hunch that the conceptual analysis of clinical judgment would reveal a structure not so very different — despite the clear difference in ends — from that of scientific thought, I find a good deal to question in the categories Dr. Pellegrino uses in his exposition. He seems to be distinguishing “science, dialectic, ethics, art and rhetoric” in the spirit of the Aristotelian division of the sciences, a division, in my view, almost wholly inappropriate, in the terms in which Aristotle made it, to any modern philosophical discussion of the nature of science or disciplines like clinical medicine that exist in some practical, if not in a strict conceptual, relation to it.