scholarly journals The influence of patient's age on clinical decision-making about coronary heart disease in the USA and the UK

2006 ◽  
Vol 26 (2) ◽  
pp. 303-321 ◽  
Author(s):  
ANN ADAMS ◽  
CHRISTOPHER D. BUCKINGHAM ◽  
SARA ARBER ◽  
JOHN B. MCKINLAY ◽  
LISA MARCEAU ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Clinical Decision Making ◽  
Health Care Systems ◽  
Clinical Decision ◽  
Adverse Outcomes ◽  
Patients Âgés ◽  
Co Morbidity

This paper examines UK and US primary care doctors' decision-making about older (aged 75 years) and midlife (aged 55 years) patients presenting with coronary heart disease (CHD). Using an analytic approach based on conceptualising clinical decision-making as a classification process, it explores the ways in which doctors' cognitive processes contribute to ageism in health-care at three key decision points during consultations. In each country, 56 randomly selected doctors were shown videotaped vignettes of actors portraying patients with CHD. The patients' ages (55 or 75 years), gender, ethnicity and social class were varied systematically. During the interviews, doctors gave free-recall accounts of their decision-making. The results do not establish that there was substantial ageism in the doctors' decisions, but rather suggest that diagnostic processes pay insufficient attention to the significance of older patients' age and its association with the likelihood of co-morbidity and atypical disease presentations. The doctors also demonstrated more limited use of ‘knowledge structures’ when diagnosing older than midlife patients. With respect to interventions, differences in the national health-care systems rather than patients' age accounted for the differences in doctors' decisions. US doctors were significantly more concerned about the potential for adverse outcomes if important diagnoses were untreated, while UK general practitioners cited greater difficulty in accessing diagnostic tests.

scholarly journals Diagnostic Certainty as a Source of Medical Practice Variation in Coronary Heart Disease: Results from a Cross-National Experiment of Clinical Decision Making

2009 ◽  
Vol 29 (5) ◽  
pp. 606-618 ◽  
Author(s):  
Karen E. Lutfey ◽  
Carol L. Link ◽  
Lisa D. Marceau ◽  
Richard W. Grant ◽  
Ann Adams ◽  
...  
Keyword(s):  
Health Care ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Medical Practice ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
The United States ◽  
Practice Variation ◽  
Diagnostic Certainty ◽  
Cross National

The authors examined physician diagnostic certainty as one reason for cross-national medical practice variation. Data are from a factorial experiment conducted in the United States, the United Kingdom, and Germany, estimating 384 generalist physicians’ diagnostic and treatment decisions for videotaped vignettes of actor patients depicting a presentation consistent with coronary heart disease (CHD). Despite identical vignette presentations, the authors observed significant differences across health care systems, with US physicians being the most certain and German physicians the least certain (P < 0.0001). Physicians were least certain of a CHD diagnoses when patients were younger and female (P < 0.0086), and there was additional variation by health care system (as represented by country) depending on patient age (P < 0.0100) and race (P < 0.0021). Certainty was positively correlated with several clinical actions, including test ordering, prescriptions, referrals to specialists, and time to follow-up.

What Is Medical Ethics Consultation?

2008 ◽  
Vol 36 (1) ◽  
pp. 95-118 ◽  
Author(s):  
Giles R. Scofield
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Medical Ethics ◽  
Medical Technology ◽  
Clinical Decision Making ◽  
Ethics Consultation ◽  
Clinical Decision ◽  
Law Students ◽  
Medical Ethicist ◽  
Care Decision

As everybody knows, advances in medicine and medical technology have brought enormous benefits to, and created vexing choices for, us all – choices that can, and occasionally do, test the very limits of thinking itself. As everyone also knows, we live in the age of consultants, i.e., of professional experts who are ready, willing, and able to give us advice on any and every conceivable question. One such consultant is the medical ethics consultant, or the medical ethicist who consults.Medical ethics consultants involve themselves in just about every aspect of health care decision making. They help legislators and judges determine law, hospitals formulate policies, medical schools develop curricula, etc. In addition to educating physicians, nurses, and lawyers, amongst others, including medical, nursing, and law students, they participate in clinical decision making at the bedside.

HEALTH TECHNOLOGY ASSESSMENT AND CLINICAL DECISION MAKING:

1999 ◽  
Vol 15 (3) ◽  
pp. 585-592 ◽  
Author(s):  
Alicia Granados
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Health Technology Assessment ◽  
Case Studies ◽  
Technology Assessment ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Health Technology ◽  
Evidence Based ◽  
Systematic Process

This paper examines the rationality of the concepts underlying evidence—based medicineand health technology assessment (HTA), which are part of a new current aimed at promoting the use of the results of scientific studies for decision making in health care. It describes the different approaches and purposes of this worldwide movement, in relation to clinical decision making, through a summarized set of specific HTA case studies from Catalonia, Spain. The examples illustrate how the systematic process of HTA can help in several types of uncertainties related to clinical decision making.

The impact of new technologies on clinical decision-making in health care

Science ◽  
2015 ◽  
Vol 350 (6266) ◽  
pp. 1397-1397
Author(s):  
R. Rosenquist Brandell ◽  
O. Kallioniemi ◽  
A. Wedell
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Clinical Decision Making ◽  
New Technologies ◽  
Clinical Decision ◽  
The Impact
Sign in / Sign up

Export Citation Format

Share Document