Medical Wisdom

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.