How Doctors Think – Kathryn Montgomery

For the second time in as many months I’ve managed to read two books with the same title and, in this case, remarkably similar themes. Montgomery comes from an English literature background but teaches within a medical faculty and uses this unique perspective to explore, like Jerome Groopman did in his work of the same name, clinical decision making and judgement.
There were several notable discussions – I was particularly interested in the section on experience becoming perceived as self evident and common sensical as the acquisition of knowledge becomes subsumed into the thinking of the individual and the learning of it is forgotten. Though I was aware of the phenomenon, seeing it in my own work, I wasn’t aware of the body of literature and exploration of the process and it’s effects, and I’ll follow it up as part of my own studies.
However, I found the writing to be in general overly academic and dry. Woven throughout the text is a narrative – the experiences of Montgomery when her daughter was diagnosed with breast cancer. In many cases this significantly colours how Montgomery views the practice of medicine and the teaching of undergraduates. I didn’t feel as though the inclusion of the author’s I in the text brought any useful information, though her focus on it is clearly significant and the effect of the diagnosis on the author was unmistakably profound. Unlike Groopman’s narratives, though, we get no insight into how the individual practitioner’s clinical judgement is enhanced or affected by the way they think or their experiences, an element that set Groopman above most writers in the area.
It’s perhaps unfair to compare the two writers – their styles, backgrounds and points of view are so disparate, although their topic is so similar. Yet, perhaps because of the proximity of my readings, and because of the superlative nature of the first exploration of this topic, comparison is inevitable. Montgomery’s take is less accessible, even taking into account it’s academic intended audience, and less clinically valuable. I may well try rereading it in a few months, when Groopman’s work is less clear in my mind, for I’m sure this text has merit, but I had trouble finding it this time around. - Alex