decision making

Question 1

types of problems:
all patient present to a doctor which can either be old problems or new one this new one an be well as — consultation or — consultation and another new problem is the sick can either — or — and when they are this we ca either diagnosis — or — established or diagnosed established during — or problems remains — which requires —

Answer 1

well
administrative
preventative
urgent
non urgent
obvious or rapidly
during consultation
undifferentiated
further consultations

Question 2

— headaches are the most common type of headache presenting to primary care, estimated yearly prevalence of at least 40%.
the conscientious explicit and judicious use of current best evidence in making decisions about care of individual patients is known as — medicine
sources can be: up to date, dynamed, clinical evidence, cochrane library, BMJ clinical evidence
Only limited evidence available about the treatment of —
1-Regular acute pain relief-” insufficient evidence re benefits of common analgesics”
2-Relaxation- “insufficient evidence re benefits”
3- CBT- “limited evidence that CBT reduced symptoms of chronic TTH @ 6 months V’s placebo”

Answer 2

tension type headaches TTH
evidence based medicine
chronic TTH

Question 3

-Accident and Emergency
-Imaging-MRI/CT- publically or privately, time frame and cost?
-Out patients – headache clinic, time frame and cost
-Medical assessment unit ? Available
are all under — options
whats influencing our decision for these are:
1- — factors- fear of litigation, time pressure, past experience (previous bad case)
2- Your – of the differential diagnosis and how common each condition is
3- – to patient- financial, time ,other e.g. radiation
4- — available
5- Length of – to be seen
6- — choice, ideas and concerns
7- —- issues- babysitter, family support

Answer 3

doctors
knowledge
cost
services
length of time
patient choices
psychosocial

Question 4

how are clinical decisions made:
1- doctors – of evidence skills n attitude
2- health care – rules as PBS and medicare funding
3- concern about —
4- patienrs — , — , –

Answer 4

knowledge
access
litigation
values concerns n expectations

Question 5

how doctors make decisions:
1- — approach – rational/normative
eg full systematic history, examination, differential diagnosis, as we have just done for headache. — process
2- — approach- more automatic
pattern recognition or spot diagnosis eg herpes zoster (‘shingles’)
A – process used increasingly as doctors — experience

Answer 5

analytical
slower
intuitive ( however it can cause errors)
faster
gain experience

Question 6

diagnostic errors:
- most errors occur when thinking in an — so be aware of the thinking modes
- its important to – on ur decision when thinking intuitively to ensure you are correct
-Rate of diagnostic error in medicine is likely to be in the range of 5-15%
(Berner and Graber 2008)
-Approximately 5% of autopsies (US) reveal lethal diagnostic errors; correct diagnosis and treatment could avert death (JAMA, 2009;301;100-1062 )

Answer 6

initiative
reflect

Question 7

so how can we reduce the errors relating to our decision making:
1- Obtain a complete — and use this to generate – hypothesis
2- Perform a — but – and purposeful — examination
3- Use a – approach to obtain diagnostic possibilities to be considered
4-Take time to pause and —
5-Embark on the plan but acknowledge uncertainty and ensure pathways for –
(Be aware of whether you are in intuitive or analytical modes and take time to stop and think)

Answer 7

history
initial
comprehensive but focused
systemic
reflect
follow ups