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Exploring Medical Decision-Making: From Today's Heretic to Tomorrow's Doctor

Dive into the world of medical decision-making, exploring evidence-based medicine's impact and sparking excitement about studying medicine. Gain insights into broad thinking in healthcare and evolve from a "Heretic" student to a patient partner. Understand the role of a doctor in 2008 versus 2028 and beyond, while exploring why we seek medical advice and the different goals for patients and healthcare providers. Discover the crucial sources of diagnostic data, nuances of data collection, and the art of thinking like a doc in the fields of science and medicine. Delve into therapeutic interventions and the balance between patient care and system costs.

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Exploring Medical Decision-Making: From Today's Heretic to Tomorrow's Doctor

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  1. Medical Decision-Making andClinical Research

  2. Class Format • 5-10 minute quiz

  3. Class Format • 5-10 minute quiz on readings • Interactive

  4. Class Format • 5-10 minute quiz on readings • Interactive • Didactics, prn

  5. Class Format • 5-10 minute quiz on readings • Interactive • Didactics, prn • Work as a group

  6. Goals • Explore the ways that doctors make decisions

  7. Goals • Explore the ways that doctors make decisions • See how the application of “evidence-based medicine” affected, affects and will affect medical decision-making

  8. “goals” • Get you excited about studying medicine

  9. “goals” • Get you excited about studying medicine • Get you comfortable with the idea that you can study medicine, if …

  10. “goals” • Get you excited about studying medicine • Get you comfortable with the idea that you can study medicine • Get you to think broadly, expansively, daringly, insightfully about medicine

  11. “goals” • Get you excited about studying medicine • Get you comfortable with the idea that you can study medicine • Get you to think broadly, expansively, daringly, insightfully about medicine • Get you to be a “Heretic”

  12. Heretic

  13. Heretic • Teacher-student

  14. Heretic • Teacher-student  Colleague-mentor

  15. Heretic • Teacher-student  Colleague-mentor • Pre-med

  16. Heretic • Teacher-student  Colleague-mentor • Pre-med  Medicine

  17. Heretic • Teacher-student  Colleague-mentor • Pre-med  Medicine • “Rememberer”

  18. Heretic • Teacher-student  Colleague-mentor • Pre-med  Medicine • “Rememberer”  Efficient data gatherer-applier

  19. Heretic • Teacher-student  Colleague-mentor • Pre-med  Medicine • “Rememberer”  Efficient data gatherer-applier • Health care provider

  20. Heretic • Teacher-student  Colleague-mentor • Pre-med  Medicine • “Rememberer”  Efficient data gatherer-applier • Health care provider  Patient partner

  21. Heretic • Teacher-student  Colleague-mentor • Pre-med  Medicine • “Rememberer”  Efficient data gatherer-applier • Health care provider  Patient partner

  22. Heretic • Teacher-student  Colleague-mentor • Pre-med  Medicine • “Rememberer”  Efficient data gatherer-applier • Health care provider  Patient partner • My patient

  23. Heretic • Teacher-student  Colleague-mentor • Pre-med  Medicine • “Rememberer”  Efficient data gatherer-applier • Health care provider  Patient partner • My patient  Our patients

  24. Heretic • Teacher-student  Colleague-mentor • Pre-med  Medicine • “Rememberer”  Efficient data gatherer-applier • Health care provider  Patient partner • My patient  Our patients • Doctor for 2008

  25. Heretic • Teacher-student  Colleague-mentor • Pre-med  Medicine • “Rememberer”  Efficient data gatherer-applier • Health care provider  Patient partner • My patient  Our patients • Doctor for 2008  Doctor for 2028 …

  26. Heretic • Teacher-student  Colleague-mentor • Pre-med  Medicine • “Rememberer”  Efficient data gatherer-applier • Health care provider  Patient partner • My patient  Our patients • Doctor for 2008  Doctor for 2028 and Beyond!

  27. Why Go to a Doctor?

  28. Why Go to a Doctor? • Solve an acute problem

  29. Why Go to a Doctor? • Solve an acute problem • Manage a chronic problem

  30. Why Go to a Doctor? • Solve an acute problem • Manage a chronic problem • Screen for disease to treat at earliest time  best chance of cure????

  31. Why Go to a Doctor? • Solve an acute problem • Manage a chronic problem • Screen for disease to treat at earliest time  best chance of cure???? • Advise on changing lifestyle issues

  32. Different Goals MD GoalsPatient Goals Outcome (+)/optimal Get better … optimal Dx and Tx “correct” Feel better Quick Quick Paid Cheap Learn for future patients Am I going to get better? When?

  33. Sources of Diagnostic Data Symptoms (hx) = patient reports Signs (px) = examiner observes Investigations = lab, radiology, …

  34. Nuances of Data Collection • Open versus Closed • Narrative versus Directed • History versus Physical versus Investigations • Categorization (yes / no) Interobserver reliability: Kappa

  35. Information Resources • Experience • Teachers/Training • Books • “The Literature” • 4 S organization of evidence

  36. Thinking Like a Doc ≠ Science Science Medicine Synthetically vs. Analytically forward vs. backward cause  outcome vs. outcome  cause

  37. Thinking Like a Doc ≠ Science Science/Synthetically/Forward/Cause to Outcome • car out of gas on railroad crossing  train wreck • Etiologies  Pathology Medicine/Analytical/Backward/Outcome to Cause • train wreck  car out of gas on railroad crossing • Pathology  Etiology (fixable?)

  38. Valleys of Medical Education

  39. Therapeutic Interventions • Primum no nocere • Cost : Benefit analysis • Systems cost vs. physician's contract

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