TAILIEUCHUNG - Chapter 003. Decision-Making in Clinical Medicine (Part 4)

Major Influences on Clinical Decision-Making More than a decade of research on variations in clinician practice patterns has shed much light on forces that shape clinical decisions. The use of heuristic "shortcuts," as detailed above, provides a partial explanation, but several other key factors play an important role in shaping diagnostic hypotheses and management decisions. These factors can be grouped conceptually into three overlapping categories: (1) factors related to physicians' personal characteristics and practice style, (2) factors related to the practice setting, and (3) factors related to economic incentives. Factors Related to Practice Style One of the key roles of the. | Chapter 003. Decision-Making in Clinical Medicine Part 4 Major Influences on Clinical Decision-Making More than a decade of research on variations in clinician practice patterns has shed much light on forces that shape clinical decisions. The use of heuristic shortcuts as detailed above provides a partial explanation but several other key factors play an important role in shaping diagnostic hypotheses and management decisions. These factors can be grouped conceptually into three overlapping categories 1 factors related to physicians personal characteristics and practice style 2 factors related to the practice setting and 3 factors related to economic incentives. Factors Related to Practice Style One of the key roles of the physician in medical care is to serve as the patient s agent to ensure that necessary care is provided at a high level of quality. Factors that influence this role include the physician s knowledge training and experience. It is obvious that physicians cannot practice evidence-based medicine EBM described later in the chapter if they are unfamiliar with the evidence. As would be expected specialists generally know the evidence in their field better than do generalists. Surgeons may be more enthusiastic about recommending surgery than medical doctors because their belief in the beneficial effects of surgery is stronger. For the same reason invasive cardiologists are much more likely to refer chest pain patients for diagnostic catheterization than are noninvasive cardiologists or generalists. The physician beliefs that drive these different practice styles are based on personal experience recollection and interpretation of the available medical evidence. For example heart failure specialists are much more likely than generalists to achieve target angiotensinconverting enzyme ACE inhibitor therapy in their heart failure patients because they are more familiar with what the targets are as defined by large clinical trials have more familiarity with .

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