Clinical Decision Making Flashcards
What are the three classes of acuity?
Critically life threatening
Potentially life threatening
Not life threatening
What are some obvious, critical, life-threatening presentations?
Major, multi-system trauma
Devastating single system trauma
End-stage disease presentations
Acute presentations of chronic conditions
What are some examples of potentially life-threatening presentations?
Serious, multi-system trauma
Multiple disease etiologies
What are some examples of non-life threatening presentations?
Minor illness or injury
EMS system misuse/abuse
How do we, as paramedics, make decisions? (4)
Protocol drive, they are standing orders and are algorhythmic
Pattern recognition
Worst case scenario
Event driven
What are seven fundamental knowledge and abilities for paramedics?
Anatomy, physiology and pathophysiology
Focusing on large amounts of data
Organizing information
Identifying and dealing with medical ambiguity
Differentiating between relevant and irrelevant data
Analyzing and comparing similar situations
Explaining decisions and constructing logical arguments
What are some facilitating behaviours when dealing with decision based management?
Stay calm, do not panic
Assume and plan for the worst, err on the side of the patient
Maintain a systematic assessment pattern
Balance analysis, data processing and decision making styles
Remain adaptable
What are three useful styles of thinking?
Situation Analysis
- Reflective versus impulsive
Data Processing
- Divergent versus convergent
Decision Making
- Anticipatory versus reactive
What are some positive effects of the hormonal influences from ‘fight or flight?’
Enhanced visual and auditory acuity
Improved reflexes and muscle strength
What are some negative effects of the hormonal influences from a ‘fight or flight’ response
Impaired critical thinking skills
Diminished concentration and assessment ability
What are the sex R’s in putting it all together?
Read the scene Read the patient React Re-evaluate Revise the management plan Review your performance
What is a Commission Bias?
Results from the sense of obligation to intervene by the practitioner
What is Anchoring?
Persuaded by features early in assessment, early attachment of a diagnosis
What is Ascertainment bias?
Stereotyping and gender bias
What is Availability?
Recent experience with a disease may inflate the likelihood of it being diagnosed
What is Confirmation Bias?
The tendency to look for confirming evidence to support a diagnosis rather than look for reasons not to support diagnosis
What is a Diagnosis Momentum?
Once diagnostic labels are attached to a patient they become stickier and stickier. Tough to shake a diagnosis once one has been declared
What is the Framing Effect?
How you see things will be strongly influenced by the way in which the problem is framed
What is the Fundamental Attrition Error?
The tendency to be judgemental and blame patients for their illness rather than examine the facts
What is the Gambler’s Fallacy?
Making risky diagnosis based on recent trends or likelihoods
What is the Omission Bias?
The tendency towards inaction to avoid perceived harm to the patient
What is the Outcome Bias?
Opting for diagnosis that lead to good outcomes rather than those that associated with bad outcomes
What is Overconfidence Bias?
It is a universal tendency to believe we know more than we do
What is Playing the Odds?
The tendency to opt for a benign diagnosis, on the basis that it is more likely than a serious one
What is the Posterior Probability Error?
Occurs when you over value past experiences of a patient as a basis for making decisions on current problems
What is the Psych-Out Error
Psychiatric patients appear to be particularly vulnerable to errors
What is Search Satisficing?
Reflects the universal tendency to call off a search once something is found - even if the search was not completed
What are Sunk Costs?
The more clinicians invest in a particular diagnosis, the less likely they may be to release it and consider alternatives
What is the Unpacking Principle?
It is the failure to elicit all relevant information in establishing a differential diagnosis may result in significant possibilities being missed
What is acuity of a patient?
The severity or acuteness of a patient’s condition
