Clinical judgement and individual patients: INVITED COMMENTARY ON ... IN DEFENCE OF PROFESSIONAL JUDGEMENT

Abstract

Like Robin Downie and Jane Macnaughton, I think that judgement lies at the heart of good clinical practice in psychiatry [Downie and Macnaughton 2009]. I fully agree with the central thrust of their paper. But in this commentary, I wish to sound a note of caution about their likely success in defending clinical judgement against those who criticise or neglect it without some further augmentation of their strategy. My assumption is that their paper is intended to be programmatic. Thus I do not wish to criticise it as incomplete (they have written much more elsewhere, eg.). Rather, my concern is that the route to a defence of judgement that it suggests is not the best route. Of course, my own brisk criticism and positive outline is even more programmatic.
In their paper, Downie and Macnaughton suggest that two factors disguise the central role of judgement in good clinical practice. One is the misapplication of numerical codification to judgement based on qualitative research and the other is the rise of a consumer model of healthcare. In this short note, I will ignore both the consumer model of healthcare and the idea that qualitative research is connected to clinical judgement. I will focus instead on the brief characterisation of clinical judgement that they offer in the discussion of the latter.