Good medical practice

1. Good medical practice

2. Patients and doctors differ in their beliefs, attitudes and expectations • Good medical practice, or the art of medicine, depends on the ability to recognise and respect these differences and to treat every patient as an individual

3. Medicine is a profession that incorporates science and the scientific method with the art of being a physician • The art of tending to the sick is as old as humanity itself • Even in modern times, the art of caring and comforting, guided by common sense & medical ethics, remains the cornerstone of medicine

4. The doctor-patient relationship is in itself therapeutic • A successful consultation with a trusted and respected doctor will therefore have beneficial effects irrespective of any other therapy given

5. Good communication is the single most important component of good medical practice because it identifies problems quickly and clearly, defines expectations, and helps to establish trust between the clinician and patient

6. Failures in communication lead to poor health outcomes, strained working relations, widespread dissatisfaction among patients, their families and health professionals, anger and litigation • Poor communication is commonplace in most health-care systems and has become the root cause of most complaints

7. At the beginning of a medical consultation many patients feel ill and most will be apprehensive • Their distress will be enhanced and effective communication will be impossible if the clinician appears indifferent, unsympathetic and short of time

8. First impressions are critical and it is essential that the patient be put at ease by appropriate introductions and a friendly greeting • The clinician must ensure that the patient feels that he or she is the centre of interest

9. The main aim of a medical interview is to establish a factual account of the patient's illness • Explore the patient's own feelings, determine how they interpret their symptoms, and unearth all their concerns and fears before suggesting and agreeing a plan of management

10. These goals will not be met unless clinicians demonstrate understanding and empathy • Empathy is not the same as sympathy (feeling sorry for the patient), which is rarely helpful

11. Most patients have more than one concern and will be reluctant to discuss potentially important issues if they feel that the clinician is not interested, or is likely to dismiss their complaints as irrational or trivial

12. Listening and talking to the patient with care and skill will usually lead to a provisional diagnosis, establish rapport, and determine which investigations are likely to be most productive • The doctor must ensure that dignity is preserved and that the patient feels comfortable throughout the examination

13. Good doctors never stop learning, and continue to develop their knowledge, skills and attributes throughout their working lives, to the benefit of their patients and themselves

14. Modern medical practice has become dominated by sophisticated and often expensive investigations • It is easy to forget that the judicious use of these tools, and the interpretation of the data that they provide, is crucially dependent on good basic clinical skills

15. A test should only be ordered if it is clear that the result will influence the patient's management and the perceived value of the resulting information exceeds the anticipated discomfort, risk and cost of the procedure

16. Medical management decisions are made by weighing up the benefits & risks of a procedure or treatment • Involve patients, and their families, in the decision-making process and explain risk in an accurate and understandable way

17. Providing the relevant biomedical facts is seldom sufficient to guide decision-making because a patient's perception of risk is often coloured by emotional, and sometimes irrational factors

18. Most patients have access to information from a wide variety of sources • The clinician must therefore be aware of and sensitive to the way in which these resources influence the patient

19. Clarify the problem and present the evidence base • Terms such as 'common', 'rare', 'probable' and 'unlikely' are elastic • Clinician should quote numerical information using denominators (e.g. '90 of every 100 patients who have this operation feel much better, 1 will die during the operation and 2 will suffer a stroke')

20. Positive framing ('There is a 99% chance of survival') and negative framing ('There is a 1% chance of death') may both be appropriate

21. The best available health care can be expensive & no country can now afford it • Health-care systems must therefore take account of the cost-effectiveness of the treatments they provide

22. Prevention is easier, cheaper and more effective than cure for many diseases • Curative medicine is immediate, highly visible and glamorous • Acute medical care produces immediate and gratifying results while treating chronic illness is time-consuming and less rewarding

23. Most medical management guidelines are derived from studies that were conducted in well-resourced health-care systems • In trying to apply this knowledge to the developing world, there are tensions between best practice and what is possible

24. The best possible practice is that which can be delivered within the available resources in a specific setting • Compassionate care given with empathy, understanding and good communication is always within the physician's reach, even when physical resources are inadequate

25. Evidence-Based Medicine • The "art of medicine" is defined traditionally as a practice combining medical knowledge (including scientific evidence), intuition, and judgment in the care of patients

26. EBM places greater emphasis on the processes by which clinicians gain knowledge of the most up-to-date and relevant clinical research to determine for themselves whether medical interventions alter the disease course and improve the length or quality of life

27. Practice of EBM has four key steps • Plan the management question to be answered • Search the literature and online databases for applicable research data

28. Evaluate the evidence gathered with regard to its validity and relevance • Integrating this evidence with knowledge about the unique aspects of the patient (including the patient's preferences about the possible outcomes)

29. EBM provides practitioners an ideal rather than a finished set of tools to manage pts • The contribution of EBM is to promote the development of more powerful and user-friendly EBM tools that can be accessed by busy practitioners • Bring change in the way medicine is being practiced

30. EBM has not eliminated the need for subjective judgments • Each systematic review or clinical practice guideline presents the interpretation of "experts" whose biases remain largely invisible to the review's consumers

31. It is worth remembering that the response to therapy of the "average" pt represented by clinical trial outcomes may not be same for the patient being treated by physician

32. Meta-analyses cannot generate evidence when there are no adequate randomized trials • What clinicians confront in practice will never be thoroughly tested in a randomized trial

33. Excellent clinical reasoning skills and experience supplemented by well-designed quantitative tools and a keen appreciation for individual patient preferences will continue to be of paramount importance in the professional life of medical practitioners

34. THANK YOU