TAILIEUCHUNG - Chapter 003. Decision-Making in Clinical Medicine

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. | Chapter 003. Decision-Making in Clinical Medicine 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 evidence-based medicine it is easy to overlook the importance of this elusive mental activity and focus instead on the algorithmic practice guidelines constructed to improve care. One reason for this apparent neglect is that much more research has been done on how doctors should make decisions . using a Bayesian model discussed below than on how they actually do. Thus much of what we know about clinical reasoning comes from empirical studies of nonmedical problem-solving behavior. Despite the great technological advances of medicine over the last century uncertainty still plays a pivotal role in all aspects of medical decision-making. We may know that a patient does not have long to live but we cannot be certain how long. We may prescribe a potent new .

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