The Subjective in Clinical Judgment

Abstract

Someone telephones the doctor that he has had increasing dull pain in the right side of his abdomen and back for several hours. While not exactly nauseated, he is repelled by the thought of food. He thinks the pain is the same as that of his wife when she had her gallbladder attack. The patient’s complaint is clearly subjective and of the type that most often initiates the medical act. Yet, in its subjectivity, the report lies in a domain of medical practice that is least understood, or more precisely that is least systematized. The deficiencies of medical practice in regard to the subjective are highlighted by the increasing use of the problem-oriented medical record as a tool of medical education. In Medical Records, Medical Education, and Patient Care; The Problem-Oriented Record as a Basic Tool, Lawrence Weed [4] points out the equal importance of patients’ subjective experience with objective, measurable facts of medicine. Further, Dr. Weed gives excellent examples of the kind of profiles of patients’ personal and social lives that should be included in any complete medical record.

This work supported in part by a grant from the Henry L. Blum Research Fund and the Robert Wood Johnson Foundation. With the assistance of Nancy McKenzie.