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Doody's Review ServiceReviewer: David L. Nahrwold, MD (Northwestern University Feinberg School of Medicine)
Description: This is a book about how surgeons think, how they process information, and how they use intuition in the diagnosis and management of patients. The chapter headings accurately describe the book's contents: intuition, the doctor's task and mind, the structure of knowledge, problem solving, diagnosis, decision making, judgment, and visual thinking. The authors describe what is known about intuitive thinking (judgment) and contrast it with analytical thinking (data analysis). They believe "surgical scripts," in which experienced surgeons describe how they manage clinical situations, is a good model for the education of students and residents.
Purpose: The authors point out that computers, practice guidelines, algorithms, and other aids are often not helpful in caring for the individual patient, but that surgeons who use intuitive thinking make accurate, sound judgments. They attempt to describe intuition and its applications to patient care. This is an important exercise because if the manner in which physicians think and make judgments can be codified, this knowledge could be applied in the education of students and residents, perhaps making them better clinicians.
Audience: Their audience is surgeons, other specialists, psychologists, and cognitive scientists, but the information is of some value to all educators. Dr. Abernathy, a surgeon, died when the book was completed and Dr. Hamm, a PhD in academic family medicine, writes eloquently of Dr. Abernathy's many ideas, conventional and unconventional.
Features: The references are adequate, as are the illustrations. The table of contents is excellent. Each chapter is preceded by its subject headings, a useful feature for browsing.
Assessment: Coverage of the various elements of surgical thinking and judgment is thorough. One gets a feel for what judgment is, but it is difficult to understand it entirely. The book is not highly organized and one chapter does not necessarily flow into another. The authors' distaste for practice guidelines, protocols, and other such staples of modern patient management is evident. This is an interesting, but not essential, book.