Pellegrino and Thomasma’s Anatomy of Clinical Judgments Revisited

In 1981, Edmund Pellegrino and David Thomasma published A Philosophical Basis of Medical Practice. In this work, they situated the process of clinical judgment in the clinical encounter between an individual doctor and their patient. The encounter revolves around three questions: What can be wrong? What can be done? And what should be done for this patient? They analyzed the complete process of clinical reasoning involving both technical and ethical aspects. Pellegrino and Thomasma's subsequent work focused more on professionalism and ethics, while more recent analysis of clinical decision-making has been in the realm of psychology rather than along philosophical lines, particularly in the use of dual-process theory. Here we seek to review Pellegrino and Thomasma's analysis and to reintegrate the technical and ethical aspects of clinical reasoning.