Clinical Judgement - Chapter 2 (Continued)
Key point from last Class
• Clinical practice is not simply a matter applying research evidence to patients.
• Clinical practice is like detective work because its goal is na individualized truth about a
• Clinical practice is also involves a judgement about what is best for the patient
• Anecdotes are very useful source of information in clinical practice.
Gravação de áudio iniciada: 8:40 AM January-30-14
→It is useful to think of two stages to clinical practice:
• Diagnoses stage - the project leading up the consulation and diagnosis of the problem.
• Treatment stage - the period after diagnosis that includes treatment of the problem
According to Downie and Macnaughton...
• Diagnosis stage involves 1) the "detective" evidence base, and 2) information from patient
• Treatment stages involves 1) the scientific evidence base, and 2) information from anecdotes
of others doctors.
• both stages involve interpretation
Interpretation is a process of "knowing about something"
• It is guided by a person's own viewpoint
• It can be different from person to person
• There are often a number of plausible interpretation
• Clinical reasoning involves making a sound interpretation
Clinical practice also involve "knowing how" to do something...
• It involves skills like:
• Tying a surgical knot
• Administring an injection
• Listening for a heart to murmur
• Plus, knowing how to communicate
• According to Downie & Mcnaughton, communication involves knowing how to explain
things in a way that fits the kowledge, ability, and interest of patient.
Clinical practice also involve conset...
• the best effort at diagnosis and treatment are blocked if the patient does not consent.
What is "consent"...
• Vonluntary agreement to or acquiescence in what another proposes
• Weakest form of consent
• Does not confer right to patient
• "Authorizing" • Permit or empower someone to carry out something
• Strong form of consent
4. Confer rights to patient, but undermines practitioner autonomy
5. "shared decision-making"
• Giving or refusing of permision
• The patient give (or refuses) the doctor a right to go ahead with the proposed
treatment (or diagnosis).
• The doctor gives the patient a right to have ( or not have) the treatmend (or
• The treatment ( or diagnosis) is sanctioned by society at large through is public
• Agreing - the main responsability remains with the doctor
• Authorizing - the main responsability remains with the patient
• Shared Decision Making - responsability is shared by patient, doctor, and society.
Downie and MC say that consent ..
Summary of Chapter 1 and 2
a good practitioner wherever she or he may be must at least be some sort of sicentist.
• But, what is the extent of sicence in clinical practice?
A practitioner has a diagnosis role and a treatment role
• In the treatment role, clinical reasoning is sicentific because it envolves a knowledge of
• Medical research is scientific i broad sense because it uses axperimetnal