TAILIEUCHUNG - Chapter 003. Decision-Making in Clinical Medicine (Part 1)

Harrison's Internal Medicine Chapter 3. Decision-Making in Clinical Medicine Decision-Making in Clinical Medicine: Introduction To the medical student who requires 2 h to collect a patient's history and perform a physical examination, and several additional hours to organize them into a coherent presentation, the experienced clinician's ability to reach a diagnosis and decide on a management plan in a fraction of the time seems extraordinary. While medical knowledge and experience play a significant role in the senior clinician's ability to arrive at a differential diagnosis and plan quickly, much of the process involves skill in clinical decision-making. The first goal. | Chapter 003. Decision-Making in Clinical Medicine Part 1 Harrison s Internal Medicine Chapter 3. Decision-Making in Clinical Medicine Decision-Making in Clinical Medicine Introduction To the medical student who requires 2 h to collect a patient s history and perform a physical examination and several additional hours to organize them into a coherent presentation the experienced clinician s ability to reach a diagnosis and decide on a management plan in a fraction of the time seems extraordinary. While medical knowledge and experience play a significant role in the senior clinician s ability to arrive at a differential diagnosis and plan quickly much of the process involves skill in clinical decision-making. The first goal of this chapter is to provide an introduction to the study of clinical reasoning. Equally bewildering to the student are the proper use of diagnostic tests and the integration of the results into the clinical assessment. The novice medical practitioner typically uses a shotgun approach to testing hoping to hit a target without knowing exactly what that target is. The expert on the other hand usually has a specific target in mind and efficiently adjusts the testing strategy to it. The second goal of this chapter is to review briefly some of the crucial basic statistical concepts that govern the proper interpretation and use of diagnostic tests. Quantitative tools available to assist in clinical decision-making will also be discussed. Evidence-based medicine is the term used to describe the integration of the best available research evidence with clinical judgment and experience in the care of patients. The third goal of this chapter is to provide a brief overview of some of the tools of evidence-based medicine. Clinical Decision-Making Clinical Reasoning The most important clinical actions are not procedures or prescriptions but the judgments from which all other aspects of clinical medicine flow. In the modern era of large randomized trials and .

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