Clinical Judgment Revisited

1999 ◽  
Vol 38 (04/05) ◽  
pp. 279-286 ◽  
Author(s):  
L. L. Weed
Keyword(s):  
Decision Making ◽  
Medical Practice ◽  
Clinical Judgment ◽  
Medical Information ◽  
Patient Records ◽  
Practice Of Medicine ◽  
The Way

AbstractIt is widely recognised that accessing and processing medical information in libraries and patient records is a burden beyond the capacities of the physician’s unaided mind in the conditions of medical practice. Physicians are quite capable of tremendous intellectual feats but cannot possibly do it all. The way ahead requires the development of a framework in which the brilliant pieces of understanding are routinely assembled into a working unit of social machinery that is coherent and as error free as possible – a challenge in which we ourselves are among the working parts to be organized and brought under control.Such a framework of intellectual rigor and discipline in the practice of medicine can only be achieved if knowledge is embedded in tools; the system requiring the routine use of those tools in all decision making by both providers and patients.

Limits—The Role of the Law in Bioethical Decision Making, by Roger B. Dworkin. Bloomington (IN): Indiana University Press, 1996. 205 pp.

1998 ◽  
Vol 7 (1) ◽  
pp. 108-111
Author(s):  
Ben A. Rich
Keyword(s):  
Decision Making ◽  
Medical Practice ◽  
Clinical Judgment ◽  
Medical Decision ◽  
Columbia University ◽  
Indiana University ◽  
History Of ◽  
Bioethical Issues ◽  
The Law

Anyone with so much as a passing familiarity with bioethics knows how significantly and persistently (at least since mid-century) the law has insinuated itself into healthcare and the process of bioethical decisionmaking. Viewed from the insular perspective of traditional medical practice and medical ethics, it is not surprising that the “legalization” of the patient–physician relationship and clinical judgment has been characterized by some as pernicious. What is much more surprising, however, is when a book by a professor of law evinces the same jaundiced view of the role of law in this area. Nonetheless, the “limits” that Professor Dworkin considers to be inherent in the capacity of the law to resolve bioethical issues are significant, and hence in his opinion the role of the law should be severely circumscribed. This gloomy portrait of the “havoc” wreaked by law upon the landscape of medical practice, painted by a lawyer, stands in stark contrast to an earlier and much more sympathetic account offered by Columbia University historian and medical humanities professor David J. Rothman in his 1991 book Strangers at the Bedside, the informative subtitle of which is A History of How Law and Bioethics Transformed Medical Decision Making.

scholarly journals Nomograms in Urologic Oncology: Lights and Shadows

2021 ◽  
Vol 10 (5) ◽  
pp. 980
Author(s):  
Alessandro Morlacco ◽  
Daniele Modonutti ◽  
Giovanni Motterle ◽  
Francesca Martino ◽  
Fabrizio Dal Moro ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Data ◽  
Clinical Judgment ◽  
Scientific Evidence ◽  
Postoperative Phase ◽  
Urologic Oncology ◽  
Difficult Decision ◽  
Practice Of Medicine ◽  
Predictive Risk ◽  
Event Based

Decision-making in urologic oncology involves integrating multiple clinical data to provide an answer to the needs of a single patient. Although the practice of medicine has always been an “art” involving experience, clinical data, scientific evidence and judgment, the creation of specialties and subspecialties has multiplied the challenges faced every day by physicians. In the last decades, with the field of urologic oncology becoming more and more complex, there has been a rise in tools capable of compounding several pieces of information and supporting clinical judgment and experience when approaching a difficult decision. The vast majority of these tools provide a risk of a certain event based on various information integrated in a mathematical model. Specifically, most decision-making tools in the field of urologic focus on the preoperative or postoperative phase and provide a prognostic or predictive risk assessment based on the available clinical and pathological data. More recently, imaging and genomic features started to be incorporated in these models in order to improve their accuracy. Genomic classifiers, look-up tables, regression trees, risk-stratification tools and nomograms are all examples of this effort. Nomograms are by far the most frequently used in clinical practice, but are also among the most controversial of these tools. This critical, narrative review will focus on the use, diffusion and limitations of nomograms in the field of urologic oncology.

From Medical Data to Health Knowledge

1987 ◽  
Vol 26 (01) ◽  
pp. 3-12 ◽  
Author(s):  
J. M. Martin ◽  
L. Benamghar ◽  
B. Junod ◽  
P. Marrel
Keyword(s):  
Decision Making ◽  
Medical Decision Making ◽  
Health Knowledge ◽  
Medical Information ◽  
Computer Systems ◽  
Medical Knowledge ◽  
Medical Data ◽  
Medical Decision ◽  
Decision Making Process ◽  
The Way

SummaryThe problems of assisting in the medical decision-making process are attracting more and more attention.Actually a certain number of computer systems have considerably improved the availability of medical data. However, we encounter some difficulties when extending these systems. In order to surmount these problems, it is necessary to proceed further in the analysis and comprehension of medical information and processes.To accomplish this goal, it is necessary to have a better understanding of the way in which a group of medical data is derived from one piece of medical knowledge and also how a chunk of medical knowledge is related to its corresponding medical data.This article is a beginning in the study of the transition from medical data to health knowledge, and this transition represents only part of the global entity, the nature, the representation, and use of medical information.

scholarly journals Whatever Happened to Evidence-Based Practice During COVID-19?

2020 ◽  
Vol 163 (2) ◽  
pp. 318-319 ◽  
Author(s):  
Helene J. Krouse
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Medical Practice ◽  
Clinical Judgment ◽  
Scientific Evidence ◽  
Evidence Based ◽  
Shared Decision ◽  
Clinical Practices ◽  
Or Groups ◽  
And Behavior

Contemporary medical practice is grounded in rigorous scientific evidence in concert with best clinical practices and informed shared decision making with patients. During these times of uncertainty, disruption, and even anxiety, it becomes critical that we engage with our patients and communities in thoughtful dialogue and realistic expectations regarding treatments surrounding COVID-19. The hope for a “miracle” cure and urgency to return back to normal times can stimulate irrational thought and behavior and even desperate measures by individuals or groups. It becomes especially important that we continue to use reasonable, informed clinical judgment in discussing the various options with patients.

Debates in Dysphagia Management: How Do You Use Evidence-Based Practice in Your Dysphagia Patient Care?

2011 ◽  
Vol 20 (4) ◽  
pp. 121-123
Author(s):  
Jeri A. Logemann
Keyword(s):  
Decision Making ◽  
Patient Care ◽  
Clinical Outcomes ◽  
Clinical Judgment ◽  
Clinical Decision Making ◽  
Evidence Based Practice ◽  
Clinical Decision ◽  
Evidence Based ◽  
Clinical Method ◽  
Do So

Evidence-based practice requires astute clinicians to blend our best clinical judgment with the best available external evidence and the patient's own values and expectations. Sometimes, we value one more than another during clinical decision-making, though it is never wise to do so, and sometimes other factors that we are unaware of produce unanticipated clinical outcomes. Sometimes, we feel very strongly about one clinical method or another, and hopefully that belief is founded in evidence. Some beliefs, however, are not founded in evidence. The sound use of evidence is the best way to navigate the debates within our field of practice.

Electronic Patient Records in Medical Practice: A Multidisciplinary Endeavor

1999 ◽  
Vol 38 (04/05) ◽  
pp. 287-288 ◽  
Author(s):  
J. van der Lei ◽  
P. W. Moorman ◽  
M. A. Musen
Keyword(s):  
Medical Practice ◽  
Patient Records ◽  
Electronic Patient Records

Patients’ practices for taking the initiative in decision-making in outpatient psychiatric consultations

2017 ◽  
Vol 13 (2) ◽  
pp. 169-184 ◽  
Author(s):  
Shuya Kushida ◽  
Takeshi Hiramoto ◽  
Yuriko Yamakawa
Keyword(s):  
Decision Making ◽  
Conversation Analysis ◽  
Treatment Decision ◽  
Close Inspection ◽  
Important Resource ◽  
Treatment Decision Making ◽  
The Way

In spite of increasing advocacy for patients’ participation in psychiatric decision-making, there has been little research on how patients actually participate in decision-making in psychiatric consultations. This study explores how patients take the initiative in decision-making over treatment in outpatient psychiatric consultations in Japan. Using the methodology of conversation analysis, we analyze 85 video-recorded ongoing consultations and find that patients select between two practices for taking the initiative in decision-making: making explicit requests for a treatment and displaying interest in a treatment without explicitly requesting it. A close inspection of transcribed interaction reveals that patients make explicit requests under the circumstances where they believe the candidate treatment is appropriate for their condition, whereas they merely display interest in a treatment when they are not certain about its appropriateness. By fitting practices to take the initiative in decision-making with the way they describe their current condition, patients are optimally managing their desire for particular treatments and the validity of their initiative actions. In conclusion, we argue that the orderly use of the two practices is one important resource for patients’ participation in treatment decision-making.

Rangda and the Goddess Durga in Bali

2017 ◽  
Vol 12 (1) ◽  
pp. 50-77
Author(s):  
Sarah Weiss
Keyword(s):  
Decision Making ◽  
Binary Opposition ◽  
Dynamic Relationship ◽  
The Witch ◽  
Purity And Impurity ◽  
Good And Evil ◽  
Negative Attributes ◽  
The Way

This article examines Rangda and her role as a chthonic and mythological figure in Bali, particularly the way in which Rangda’s identity has intertwined with that of the Hindu goddess Durga— slayer of buffalo demons and other creatures that cannot be bested by Shiva or other male Hindu gods. Images and stories about Durga in Bali are significantly different from those found in Hindu contexts in India. Although she retains the strong-willed independence and decision-making capabilities prominently associated with Durga in India, in Bali the goddess Durga is primarily associated with violent and negative attributes as well as looks and behaviours that are more usually associated with Kali in India. The reconstruction of Durga in Bali, in particular the integration of Durga with the figure of the witch Rangda, reflects the local importance of the dynamic relationship between good and bad, positive and negative forces in Bali. I suggest that Balinese representations of Rangda and Durga reveal a flux and transformation between good and evil, not simply one side of a balanced binary opposition. Transformation—here defined as the persistent movement between ritual purity and impurity—is a key element in the localization of the goddess Durga in Bali.

Interoception, categorization, and symptom perception

2018 ◽  
Author(s):  
Omer Van den Bergh ◽  
Nadia Zacharioudakis ◽  
Sibylle Petersen
Keyword(s):  
Decision Making ◽  
Medical Practice ◽  
Disease Model ◽  
Clinical Implications ◽  
Symptom Perception ◽  
Symptom Reports ◽  
The Relationship ◽  
Accurate Reflection

Medical practice and the disease model importantly rely on the accuracy assumption of symptom perception: patients’ symptom reports are a direct and accurate reflection of physiological dysfunction. This implies that symptoms can be used as a read-out of dysfunction and that remedying the dysfunction removes the symptoms. While this assumption is viable in many instances of disease, the relationship between symptoms and physiological dysfunction is highly variable and, in a substantial number of cases, completely absent. This chapter considers symptom perception as a form of unconscious inferential somatic decision-making that compellingly produces consciously experienced symptoms. At a mechanistic level, this perspective removes the categorical distinction between symptoms that are closely associated with physiological dysfunction and those that are not. In addition, it brings symptom perception in accordance with general theories of perception. Some clinical implications to understand and treat symptoms poorly related to physiological dysfunction are discussed.

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