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- W2993981525 abstract "ion from the Individuality of the Patient Abstraction from the Individual Natural History of Diseaseion from the Individual Natural History of Disease In Mrs. X's case, the thinking then proceeds to possible explana tions of the individual natural history of her failed pregnancy. These will not be formulated in terms of particularities, but, instead, in terms of unknown, theoretically possible sequelae of the selective ter mination of the two fetuses, or perhaps the built-in genetic screening mechanisms of our species, or perhaps the effectiveness of obstetric intervention to stop premature labor secondary to an incompetent cervix. This is not thinking about the natural history of this preg nancy, but of a pregnancy reconceived under various classification schemes. Mrs. X's case thus becomes just that: a case, with the defi nite article supplanted by the indefinite article. With this miniscule Clinical reasoning and medical language are principally about dis ease, not illness, a particular individual's experience of disease. The case report above says nothing about infertility as an illness that Mrs. and Mr. X experienced and will continue to experience if the luck of their physicians doesn't change. Genetics are beyond luck. Illnesses are indeed particularistic, but they are the point of departure, not the subject matter, for what medicine takes to be important: the diagnosis and management of disease. Thus, there is no direct, compassionate understanding by physicians of the patient's illness, as some would have it.6 From the very first moments of the clinical encounter with Mrs. X—in morning report, not her room!—the roomful of students and residents are thinking about the patient's history, about treatment for infertility and the multi-fetal pregnancy, and about failure of the interventions undertaken to save the pregnancy and reorganizing that history into a coherent whole in terms of the explanatory frameworks of biomedical science and accumulated clinical experience. (The usual locution, interestingly, is that the patient failed the intervention!) The particularities of the patient's experience, the presumed locus of par ticularism in medicine, drops out of the picture. This content downloaded from 207.46.13.128 on Tue, 06 Sep 2016 05:44:26 UTC All use subject to http://about.jstor.org/terms Laurence B. McCullough 367 change, Mrs. X drops out of the picture, along with the immense trag edy of infertility now compounded by possibly iatrogenic loss of her" @default.
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- W2993981525 date "1990-01-01" @default.
- W2993981525 modified "2023-09-23" @default.
- W2993981525 title "Particularism in Medicine" @default.
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