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

The ‘Number Needed to Treat’ and the ‘Adjusted NNT’ in Health Care Decision-Making

1998 ◽  
Vol 3 (1) ◽  
pp. 44-49 ◽  
Author(s):  
Jack Dowie
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Evidence Based Medicine ◽  
Clinical Decision Making ◽  
Treatment Options ◽  
Clinical Decision ◽  
Population Based ◽  
Number Needed To Treat ◽  
Evidence Based ◽  
Based Medicine

Within ‘evidence-based medicine and health care’ the ‘number needed to treat’ (NNT) has been promoted as the most clinically useful measure of the effectiveness of interventions as established by research. Is the NNT, in either its simple or adjusted form, ‘easily understood’, ‘intuitively meaningful’, ‘clinically useful’ and likely to bring about the substantial improvements in patient care and public health envisaged by those who recommend its use? The key evidence against the NNT is the consistent format effect revealed in studies that present respondents with mathematically-equivalent statements regarding trial results. Problems of understanding aside, trying to overcome the limitations of the simple (major adverse event) NNT by adding an equivalent measure for harm (‘number needed to harm’ NNH) means the NNT loses its key claim to be a single yardstick. Integration of the NNT and NNH, and attempts to take into account the wider consequences of treatment options, can be attempted by either a ‘clinical judgement’ or an analytical route. The former means abandoning the explicit and rigorous transparency urged in evidence-based medicine. The attempt to produce an ‘adjusted’ NNT by an analytical approach has succeeded, but the procedure involves carrying out a prior decision analysis. The calculation of an adjusted NNT from that analysis is a redundant extra step, the only action necessary being comparison of the results for each option and determination of the optimal one. The adjusted NNT has no role in clinical decision-making, defined as requiring patient utilities, because the latter are measurable only on an interval scale and cannot be transformed into a ratio measure (which the adjusted NNT is implied to be). In any case, the NNT always represents the intrusion of population-based reasoning into clinical decision-making.

Use of Templates for Clinical Documentation in Psychiatric Evaluations—Beneficial or Counterproductive for Residents in Training?

2012 ◽  
Vol 43 (1) ◽  
pp. 99-103 ◽  
Author(s):  
Joanna Bajgier ◽  
James Bender ◽  
Rose Ries
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Relevant Literature ◽  
Health Care Financing ◽  
Clinical Decision ◽  
Third Party ◽  
Clinical Documentation ◽  
Advantages And Disadvantages ◽  
Valid Data

In psychiatry, as in other disciplines, electronic templates are replacing handwritten records to meet health care financing regulations and requirements of third-party payers. We address whether these checklists are helpful for residents, especially those beginning training, in learning the foundational skills of their discipline and in recording a comprehensive set of patient data. An informal survey of our residents suggests that residents find the templates useful, though they have advantages and disadvantages. We also review relevant literature from psychiatry and other fields on the use of electronic templates and pose questions about how we might gauge the usefulness of the templates in residents' training and in obtaining valid data for clinical decision-making.

scholarly journals Promoting Interprofessional Communication through Situation, Background, Assessment, and Recommendation (SBAR): An Educational Technique

2021 ◽  
Vol 16 (4) ◽  
pp. 255-261
Author(s):  
Jennifer Cuchna ◽  
Sarah Manspeaker ◽  
Alison Wix
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Athletic Training ◽  
Clinical Decision Making ◽  
Athletic Trainers ◽  
Clinical Decision ◽  
Content Standards ◽  
Athletic Training Students ◽  
Interprofessional Communication ◽  
Curricular Content

Context The Board of Certification Standards of Professional Practice and the 2020 Curricular Content Standards indicate athletic trainers should establish working relationships with collaborating medical professionals and be able to communicate effectively. In addition, increased emphasis on interprofessional collaboration (IPC) in practice is apparent throughout health care professions and their educational programs. However, integrating both interprofessional communication and IPC within 1 learning opportunity can be difficult. Objective To share an educational approach aimed to enhance athletic training students' abilities and confidence in delivering patient information to physician assistant students via the situation, background, assessment, and recommendation (SBAR) technique. Background As part of the health care team, athletic trainers need to communicate with various providers while making clinically based decisions. Anecdotally, learners in their final year of health care education are not confident in their ability to make recommendations to other health care professionals. The SBAR communication strategy from the evidence-based framework TeamSTEPPS has become widely adopted in health care disciplines and may help to enhance confidence in communication. Description This learning activity enables athletic training students to use a patient case scenario to develop an SBAR for delivery via phone to a physician assistant studies student. This article describes the content, delivery methods, outcomes to date, and connection to the 2020 Curricular Content Standards. Clinical Advantage(s) This clinically relevant activity provides a low-stakes, real-life opportunity for students to practice communication skills, including the following: condensing the evaluation process, clinical decision-making skills, and the ability to make recommendations for a plan of care. Active participation in the communication process enhances reasoning skills needed for collaborative clinical decision making and the transfer of care, when applicable. Conclusion(s) Developing and implementing an interprofessional SBAR communication experience with 2 health care disciplines is an innovative strategy that bridges the gap between clinical education and actual patient care experiences while addressing curricular content needs.

scholarly journals “I can guess the month … but beyond that, I can’t tell” an exploratory qualitative study of health care provider perspectives on gestational age estimation in Rajasthan, India

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
K. Scott ◽  
S. Gupta ◽  
E. Williams ◽  
M. Arthur ◽  
U. V. Somayajulu ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Gestational Age ◽  
Age Estimation ◽  
Clinical Decision Making ◽  
Healthcare Providers ◽  
Clinical Decision ◽  
Provider Perspectives ◽  
Gestational Age Estimation ◽  
Age Estimates

Abstract Background Accurately estimating gestational age is essential to the provision of time-sensitive maternal and neonatal interventions, including lifesaving measures for imminent preterm birth and trimester-specific health messaging. Methods We explored healthcare provider perspectives on gestational age estimation in the state of Rajasthan, India, including the methods they use (last menstrual period [LMP] dating, ultrasound, or fundal height measurement); barriers to making accurate estimates; how gestational age estimates are documented and used for clinical decision-making; and what could help improve the accuracy and use of these estimates. We interviewed 20 frontline healthcare providers and 10 key informants. Thematic network analysis guided our coding and synthesis of findings. Results Health care providers reported that they determined gestational age using some combination of LMP, fundal height, and ultrasound. Their description of their practices showed a lack of standard protocol, varying levels of confidence in their capacity to make accurate estimates, and differing strategies for managing inconsistencies between estimates derived from different methods. Many frontline healthcare providers valued gestational age estimation more to help women prepare for childbirth than as a tool for clinical decision making. Feedback on accuracy was rare. The providers sampled could not offer ultrasound directly, and instead could only refer women to ultrasound at higher level facilities, and usually only in the second or third trimesters because of late antenatal care-seeking. Low recall among pregnant women limited the accuracy of LMP. Fundal height was heavily relied upon, despite its lack of precision. Conclusion The accuracy of gestational age estimates is influenced by factors at four levels: 1. health system (protocols to guide frontline workers, interventions that make use of gestational age, work environment, and equipment); 2. healthcare provider (technical understanding of and capacity to apply the gestational age estimation methods, communication and rapport with clients, and value assessment of gestational age); 3. client (time of first antenatal care, migration status, language, education, cognitive approach to recalling dates, and experience with biomedical services); and, 4. the inherent limitations and ease of application of the methods themselves.

scholarly journals Health record systems that meet clinical needs

2012 ◽  
Author(s):  
Gabriella Negrini
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Patient Safety ◽  
Health Care Professionals ◽  
Clinical Decision Making ◽  
Clinical Information ◽  
Clinical Decision ◽  
Health Record ◽  
Record System ◽  
Health Records

Introduction Increased attention has recently been focused on health record systems as a result of accreditation programs, a growing emphasis on patient safety, and the increase in lawsuits involving allegations of malpractice. Health-care professionals frequently express dissatisfaction with the health record systems and complain that the data included are neither informative nor useful for clinical decision making. This article reviews the main objectives of a hospital health record system, with emphasis on its roles in communication and exchange among clinicians, patient safety, and continuity of care, and asks whether current systems have responded to the recent changes in the Italian health-care system.Discussion If health records are to meet the expectations of all health professionals, the overall information need must be carefully analyzed, a common data set must be created, and essential specialist contributions must be defined. Working with health-care professionals, the hospital management should define how clinical information is to be displayed and organized, identify a functionally optimal layout, define the characteristics of ongoing patient assessment in terms of who will be responsible for these activities and how often they will be performed. Internet technology can facilitate data retrieval and meet the general requirements of a paper-based health record system, but it must also ensure focus on clinical information, business continuity, integrity, security, and privacy.Conclusions The current health records system needs to be thoroughly revised to increase its accessibility, streamline the work of health-care professionals who consult it, and render it more useful for clinical decision making—a challenging task that will require the active involvement of the many professional classes involved.

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