L13: Clinical Decision Making Flashcards
Def of Cinical Decision Making
Importance of Decision Making
What does decision making cover?
Steps of clinical decision making process
- Identify client’s (patient’s) goals
- Identify relevant impairments & abilities.
- Formulate plan of care.
- Investigate the literature.
- Generate a clinical hypothesis.
- Select & collect the relevant outcome measures.
- Intervene.
- Evaluate outcome of the intervention.
- Report the results in the appropriate venue.
Identify relevant impairments
& abilities
- The physician identify patients’ relevant abilities & impairments by
- Appropriate tests & measures.
- The physician & the patient formulate the treatment goals using
- The information from the patient’s history Discussed In step 1
- The tests & measures Discussed In step 2
Identify client’s (patient’s)
goals.
Interview patients to identify their goals.
- Proper history taking of the current medical condition helps subsequent selection of tests & measures.
Formulate plan of care
Different types of interventions:
* Non-pharmacological.
* Pharmacological.
* Surgical.
They have to be selected properly
Investigate the literature
Generate a clinical hypothesis
Select & collect the relevant outcome measures
- Select the appropriate outcome measures: To test validity of the clinical hypothesis.
- This requires reading some of the articles for;
- The outcome of the intervention.
- The measures used to capture the outcome.
Intervene
Evaluate outcome of the intervention
Evaluate the outcomes of a plan of care.
- So, reexamine in a follow-up visit.
Report the results in the appropriate venue
- Reporting outcomes of applying a certain intervention “e.g., acupuncture in obesity” is important.
- This would take the form of
- A case report.
- Case presentation with colleagues.
- A conference in the form of a platform or poster which would have a published abstract.
- Even better is the submission of a paper.
Questions to be asked during the course of taking care of patients
- How may I be thorough yet efficient when considering the possible causes of my patient’s problem?
- How do I characterize the information I have gathered during the medical interview and physical examination?
- How should I interpret new diagnostic information?
- How do I select the appropriate diagnostic test?
- How do I choose among several risky treatments?
How may I be thorough yet efficient when considering the possible causes of my patient’s problem?
Effective VS Efficient
Conflict between Being Efficient & Being Throught
- Trying to be efficient often conflicts with being thorough.
- This conflict has no single solution:
1. Listen to expert diagnosticians.
2. See lots of patients & learn from your mistakes.
How do I characterize the information I have gathered during the medical interview and physical examination?
Expressing Uncertainity
Scale for expressing uncertainty
A probability may apply to …..
- The present state of the patient “eg., patient has coronary artery disease”
- Or express the likelihood that an event will occur in the future “e.g., patient will experience myocardial infarction within one year”
How should I interpret new diagnostic information?
Expressing Reducing Uncertainity
- Avoid Describing uncertainty with words is difficult.
- The solution is to use numbers “probability” to express uncertainty.
what is Bayes’ theorem used to?
- Estimate how much a clinician’s uncertainty about a patient’s true state should have changed.
