HS4091 Chapter 2 Cont. - Clinical Judgement

3 Pages
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Department
Health Sciences
Course Code
Health Sciences 2711A/B
Professor
Aleksandra Zecevic

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Clinical Judgement - Chapter 2 (Continued) January-30-14 8:32 AM 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 particular patient • 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 Clinical Practice →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 anecdotes • 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"... • "Agreeing" • 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 diagnosis). • The treatment ( or diagnosis) is sanctioned by society at large through is public policy In summary • 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 research evidence. • Medical research is scientific i broad sense because it uses axperimetnal methds o
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