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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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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 • Work as a group
Goals • Explore the ways that doctors make decisions
Goals • Explore the ways that doctors make decisions • See how the application of “evidence-based medicine” affected, affects and will affect medical decision-making
“goals” • Get you excited about studying medicine
“goals” • Get you excited about studying medicine • Get you comfortable with the idea that you can study medicine, if …
“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
“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”
Heretic • Teacher-student
Heretic • Teacher-student Colleague-mentor
Heretic • Teacher-student Colleague-mentor • Pre-med
Heretic • Teacher-student Colleague-mentor • Pre-med Medicine
Heretic • Teacher-student Colleague-mentor • Pre-med Medicine • “Rememberer”
Heretic • Teacher-student Colleague-mentor • Pre-med Medicine • “Rememberer” Efficient data gatherer-applier
Heretic • Teacher-student Colleague-mentor • Pre-med Medicine • “Rememberer” Efficient data gatherer-applier • Health care provider
Heretic • Teacher-student Colleague-mentor • Pre-med Medicine • “Rememberer” Efficient data gatherer-applier • Health care provider Patient partner
Heretic • Teacher-student Colleague-mentor • Pre-med Medicine • “Rememberer” Efficient data gatherer-applier • Health care provider Patient partner
Heretic • Teacher-student Colleague-mentor • Pre-med Medicine • “Rememberer” Efficient data gatherer-applier • Health care provider Patient partner • My patient
Heretic • Teacher-student Colleague-mentor • Pre-med Medicine • “Rememberer” Efficient data gatherer-applier • Health care provider Patient partner • My patient Our patients
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
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 …
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!
Why Go to a Doctor? • Solve an acute problem
Why Go to a Doctor? • Solve an acute problem • Manage a chronic problem
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????
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
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?
Sources of Diagnostic Data Symptoms (hx) = patient reports Signs (px) = examiner observes Investigations = lab, radiology, …
Nuances of Data Collection • Open versus Closed • Narrative versus Directed • History versus Physical versus Investigations • Categorization (yes / no) Interobserver reliability: Kappa
Information Resources • Experience • Teachers/Training • Books • “The Literature” • 4 S organization of evidence
Thinking Like a Doc ≠ Science Science Medicine Synthetically vs. Analytically forward vs. backward cause outcome vs. outcome cause
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?)
Therapeutic Interventions • Primum no nocere • Cost : Benefit analysis • Systems cost vs. physician's contract