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Rational Diagnosis and Treatment: An Introduction to Clinical Decision-Making

Stephen G. Pauker, MD
JAMA. 1982;247(9):1350. doi:10.1001/jama.1982.03320340096060.
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Although clinical decision-making occupies a central role in the practice of medicine, the basic principles of this art have, until recently, rarely been discussed, formally taught, or subjected to the well-deserved scrutiny applied to most aspects of medical care. This brief, more or less readable book attempts to give both student and practitioner an armchair view of medical logic. The first edition might have served to introduce the preclinical student to uncertainties commonplace in the clinic; unfortunately, the second edition delivers far less than the reader must invest, hardly providing a modern view of a rapidly evolving field.

After reading this monograph, the student will certainly appreciate the nature of clinical reasoning and the flaws that all too often make it irrational. Wulff delineates the problems but fails to provide reasonable approaches to their solution. In fact, he dismisses the entire field of prescriptive decision-making: "I hope that no clinician


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