Mastery of quality health care and patient safety begins as soon as we open the hospital doors for the first time and start acquiring practical experience. The acquisition of such experience includes much more than the development of sensorimotor skills and basic knowledge of the sciences. It relies on effective reasoning, decision making, and communication shared by all health professionals, including physicians, nurses, dentists, pharmacists, physiotherapists, and administrators. A Primer on Clinical Experience in Medicine: Reasoning, Decision Making, and Communication in Health Sciences is about these essential skills. It describes how physicians and health professionals reason, make decisions, and practice medicine. Covering the basic considerations related to clinical and caregiver reasoning, it lays out a roadmap to help those new to health care as well as seasoned veterans overcome the complexities of working for the well-being of those who trust us with their physical, mental, and spiritual health. The book provides a step-by-step breakdown of the reasoning process for clinical work and clinical care.
It examines both general and medical ways of thinking, reasoning, argumentation, fact finding, and using evidence. Outlining the fundamentals of decision making, it integrates coverage of clinical reasoning, risk assessment, diagnosis, treatment, and prognosis in evidence-based medicine. It also: Describes how to evaluate the success (effectiveness and cure) and failure (error and harm) of clinical and community actions Considers communication with patients and outlines strategies, successes, failures, and possible remedies-including offices, bedside, intervention, and care settings Examines strategies, successes, failures, and possible remedies for communication with peers-including interpersonal communication, morning reports, rounds, and research gatherings The book describes vehicles, opportunities, and environments for enhanced professional communication, including patient interviews, clinical case reports, and morning reports. It includes numerous examples that demonstrate the importance of sound reasoning, decision making, and communication and also considers future implications for research, management, planning, and evaluation.
Ways We See, Learn, and Practice Medicine Today: Paradigms of What We Are Doing Executive Summary Not-So-Random Leading Thoughts Introductory Comments Art, Science, and Craft of Medicine Medicine as Art Medicine as Science Scientific Theory Scientific Method Medicine as Craft Deterministic vs. Probabilistic Paradigm of Medicine: Uncertainty, Fuzziness, and Chaos Probability and Clinical Uncertainty Fuzzy Theory Chaos Theory in Medicine Medicine as Philosophy: Philosophy in Medicine and Philosophy of Medicine Philosophy in Medicine Philosophy of Medicine Practice and Theory of Medicine: Which One Will You Learn? Practice of Medicine Theory of Medicine Evidence-Based Medicine and Other Evidence-Based Health Sciences Beyond the Original Concept of Evidence-Based Medicine: Evidence-Based Critical Thinking Medicine and Reflective Uses of Evidence Critical Thinking Reflective Uses of Evidence Conclusions: What Exactly Should We Teach and Learn Then? References How Physicians and Other Health Professionals Really (or Should) Think Executive Summary Not-So-Random Leading Thoughts Introductory Comments General Medical Thinking and Reasoning Basic Considerations Related to Clinical Care and Caregivers' Reasoning Our Thinking and Reasoning: Essential Definitions and Meanings Tools for Argumentation "Naked" Argument (Enthymeme) or Argument at Its Simplest: A "Two-Element" Reasoning "Classical" Form of Reasoning: Categorical Syllogism or "Three-Element" Reasoning "Modern" Form of Toulmin's Model of Argument: A "Multiple (six-) Element" Way of Reasoning to Reach Valid Conclusions Reminder Regarding Some Additional and Fundamental Considerations Challenges of Causal Reasoning within the General Context of Medical Thinking and Reasoning Causal Reasoning in a Quantitative and Qualitative Way How We Look at Causes: Single or Multiple-Sets, Chains, Webs, Concept Maps Ways of Searching for Causes Criteria of Causality Disease or Event Frequencies and Fractions in Causal Reasoning Beyond Causality: Combining Frequencies, Fractions, Risks, and Proportions Quantifying Our Uncertainties Fallacies in Medical Reasoning and Scientific Thinking in General Role of Causal Reasoning in Medical Thinking Critical Thinking, Communication, and Decision Making and Their Connection to Medical Ethics Conclusion References Reasoning in Step-by-Step Clinical Work and Care: Risk, Diagnosis, Treatment, and Prognosis Executive Summary Not-So-Random Leading Thoughts Introductory Comments "You Are at Risk." What Does This Mean and How Can It Be Mutually Understood by Us, Our Patients, and the Community? What Is "Risk" in Health Sciences? Are Risk Characteristics All the Same? Risk Factors and Risk Markers Why Are Some Risk Factors "Significant" and Others Not? Where Does Our Knowledge of Risk Factors and Markers Come From? Risk as a Subject of Argumentation Illustrative Fallacies How Do We Think about Risk? Our Ways of Reasoning about Risk "We Have a Problem Here": Properties of Meaningful Diagnosis Quality and Completeness of the Diagnostic Material How Is a Diagnosis Made? How Good Are Our Diagnostic Methods and Techniques? Diagnosis as a Subject of Argumentation Illustrative Fallacies How Do We Think and Reason in the Diagnosis Domain? "That's What We'll Do about It": Reasoning and Deciding How to Treat and if the Treatment Works Types and Levels of Medical Therapeutic and Preventive Interventions Which Treatment Works Best? How Is It Measured? Which Treatment Modality Applies to a Particular Patient? Treatment as a Subject of Argumentation Illustrative Fallacies How Do We Reason in the Domain of Treatment and Preventive Intervention? Reasoning about Prognosis: "You'll Be Doing Well" ... Making Prognosis Meaningful Differences between the Prognosis Domain and the Risk Domain What Do We Need to Know about Prognostic Events and Outcomes? What Do We Expect from Prognostic Studies in Order to Reason More Effectively about the Future of Our Patients? What Treatment Modality Best Applies to a Particular Patient? How Should We Apply What We Know to an Individual Patient? Prognosis as a Subject of Argumentation Illustrative Fallacies How Do We Think in the Domain of Prognosis? Considerations for Further Work and Understanding in the Area of Prognosis Conclusion References Clinical and Community Medicine Decision Making Executive Summary Not-So-Random Leading Thoughts Introductory Comments Decision Theory, Decision Analysis, and Decision Making in General and in Medicine How Decisions Are Made in Daily Life Direction Searching Tools through Unstructured Ways of Decision Making Direction Searching Tools through Structured Ways of Decision Making Decision Analysis Cost-Benefit/Effectiveness/Utility Analysis in Clinical Decision Making Decisions as Conclusions of an Argumentative Process Direction-Giving Tools in Decision Making Tactical Tools: Clinical Algorithms Evidence-Based Clinical Decision Path Strategic Tools for Making the Right Decisions: Clinical Practice Guidelines and Clinical Protocols Illustrative Fallacies in the Decision-Making Domain Fallacies from an Individual Perspective: Individual-Related Fallacies Reasoning-Based Fallacies: Fallacies Related to the Thinking Process behind Decision Making Fallacies from the Motivation to Decide Domain Fallacies Related to Decisions Themselves Collective-Related Fallacies: Groupthink Conclusion References How Physicians Communicate with Themselves, Their Patients, and Others: Clinical Communication and Its Vehicles Executive Summary Not-So-Random Leading Thoughts Introductory Comments How to View Communication in General and in Its Medical Context Intellectual Vehicles of Communication: Some Less and Some More Interrogative Ways of Sharing Knowledge and Experience Barking Orders Just Watch Me! Do It after Me! Pimping: A Refined Form of Bullying Uttering Wisdom Argumentation and Critical Thinking-Based and Evidence-Grounded Exchange of Data and Information: A "What Do You Think?" Type of Medicine I Socratic Dissent-A Refined Form of Pimping: A "What Do You Think?" Medicine II Instrumental Vehicles, Opportunities, and Environments for Professional Communication: Oral and Written Exchanges of Experience in Clinical Practice Patient Interviews: Admission and Opening Patients' Charts Verbal, Oral, and Written Communication Nonverbal Communication Revisiting the Patient: Updating Opening Interview and Record through Bedside Communication and Progress Notes (SOAPs) Narratives and Clinical Case Reports Clinical Consultations as Narratives Clinical Vignettes and Clinical Case Reports Morning Reports Morbidity and Mortality Reports and Rounds Journal Clubs Other Types of Rounds Mostly One-Way Communication Vehicles: Consults, Referrals, Discharge Notes, and Summaries Scut Work Formal (Magisterial) Lectures Medical Articles and Other Scientific Papers Other Forms of Communication Illustrative Fallacies in Communication Slippery Slope Fallacy (Domino Theory, Argument of the Beard, Barefoot, Beard Fallacy, Domino Fallacy, Reductio Ad Absurdum, Slippery Slope Argument) Gambler's Fallacy Appeal to Consequences Fallacy (Wishful Thinking) Self-Evidence Fallacy (Mystical Assertion, Blind Conviction) Appeals to Anything Other Than the Best Evidence ("Low Instincts") Alternative Choice Fallacy Complementary Treatment Fallacy Blinding with Science Fallacy Conclusion: From Patient Problem Solving Dialogue to a Broader Communication by Knowledge Translation in Medicine References Conclusions (with a Short Recapitulation): Welcome to the World of Reasoned and Evidence-Based Medicine Glossary: Preferred Terms and Their Definitions in the Context of this Book