Medical Decision-Making

1. Medical Decision-Making Keith Bradley, MD Director Research Associates Program at St. Vincent’s National Alliance of RA Programs

2. Three (3) Modes of Diagnosis • Pattern Recognition (“Augenblick”) • Branching • Matching

3. Augenblick “blink of an eye” See it; know it

5. ABC’s • A = asymmetric • B = border irregular • C = color black or variable • D = diameter > 1/4”

14. Branching

15. Branching e.g., Chest Pain

16. Branching e.g., Chest Pain • “expert”

17. Branching e.g., Chest Pain • “expert” • “blinders”

18. Branching e.g., Chest Pain • “expert” • “blinders” •  potential for error

19. Branching e.g., Chest Pain • “expert” • “blinders” •  potential for error • “practice”

20. Matching

21. Matching • ALL possible diagnoses on x-axis

22. Matching • ALL possible diagnoses on x-axis • Each possible • symptom • sign on y-axis • investigation result

23. Matching • ALL possible diagnoses on x-axis • Each possible sx, px, tx on y-axis • = Excel spreadsheet

24. Matching • ALL possible diagnoses on x-axis • Each possible diagnoses on y-axis • = Excel spreadsheet • Lawrence Weed, MD / “couplers”

25. Different Types of Problems  Different Types of Responses

26. Non-Traumatic Unconsciousness

27. Non-Traumatic Unconsciousness • Airway

28. Non-Traumatic Unconsciousness • Airway • Breathing

29. Non-Traumatic Unconsciousness • Airway • Breathing • Circulation

30. Non-Traumatic Unconsciousness • Airway • Breathing • Circulation • Defibrillate

31. Types of Problems  Types of Responses ProblemResponse Acute  Rapid, simple, memorized

32. Fever, Ear Pain in a 3 year old

33. Fever, Ear Pain

34. Fever, Ear Pain

35. Fever, Ear Pain • Dx = acute otitis media • Tx = depending on timing: nothing or Abs

36. Types of Problems  Types of Responses ProblemResponse Acute  Rapid, simple, memorized Routine  Routine, stylized

37. “My leg is swollen”

38. “My leg is swollen” • What would Dr. House do?

39. “My leg is swollen” • What would Dr. House do? • DDx

40. “My leg is swollen” • What would House do? • DDx • Key Question … never forget to ask = ?

41. “My leg is swollen” • What would House do? • DDx • Key Question … never forget to ask • Be the star!

42. “My leg is swollen” • What would House do? • DDx • Key Question … never forget to ask • Be the star! • thick smear … draw blood at night

44. “My leg is swollen” • Dx = filiariasis

45. “My leg is swollen” • Dx = filiariasis • Tx = anti-helminths or …

46. “My leg is swollen” • Dx = filiariasis • Tx = anti-helminths or … • The parasites responsible for filariasis have a population of symbiotic bacteria, Wolbachia, that live inside the worm. • When the symbiotic bacteria are killed by the antibiotic, the worms themselves also die. • Doxycycline might be effective • Clinical trials in June 2005 by the Liverpool School of Tropical Medicine reported that an 8 week course almost completely eliminated microfilariaemia.[4][5]

49. Types of Problems  Types of Responses ProblemResponse Acute  Rapid, simple, memorized Routine  Routine, stylized Unique  Unique

50. MVC, Multiple Trauma