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Medical Decision-Making and Clinical Research

Medical Decision-Making and Clinical Research. Class Format. 5-10 minute quiz. Class Format. 5-10 minute quiz on readings Interactive. Class Format. 5-10 minute quiz on readings Interactive Didactics, prn. Class Format. 5-10 minute quiz on readings Interactive Didactics, prn

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Medical Decision-Making and Clinical Research

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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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