Another example of the importance of clinical judgement

1

Category : Clinical articles, General, Medical Rants

Medical decision making should never become formulaic. While I use, and have developed, clinical prediction rules, we must always remember that they are merely diagnostic or prognostic tests. Tests provide us some information, but we should always use them in the context of the patient in front of us.

Community acquired pneumonia-Pneumonia severity index falls short

…These AJM authors reviewed 3065 admissions in Edmonton with a diagnosis of CAP over a 2 year period. 586 (19.1%) were classified as “low risk” using the PSI. Was the hospitalization of ” low risk” patients a shameless, thoughtless waste of precious medical resources? Apparently not. Almost half ( 48.4%) were sick enough to be in the hospital for more than five days.19% suffered one or more complications and 31% were still unable to ear or drink to maintain hydration by the fifth hospital day. Clearly the admitting physician’s clinical judgment appropriately overruled the PSI score. Fine’s classification system keys to mortality rate.Those in risk classes I to III have a < 1 % mortality rate.The authors point out that the PSI does not work if the patient has COPD or pulmonary fibrosis or HIV infection or immuno suppression, etc. etc. and there are important prognostic factors not captured by the Fine index including nausea,shortness of breath and diarrhea . Their final sentence is: " It is clear that low-risk patients are a heterogenous group and that a low risk for mortality is not the only factor to be considered in admission decisions".Fortunately for a significant number of patients with CAP, the admitting physicians used what seems to often elude guidelines and algorithms namely clinical judgement...

Retired doc makes a most important point. Physician excellence is manifested by excellent clinical judgement. I know of no quality score which measures clinical judgement.

In taking with some faculty colleagues yesterday, I opined that the biggest difference between 1st and 3rd year residents was in their clinical judgement. That is what we teach during residency. All the faculty agreed enthusiastically.

Clinical judgment cannot be taught quickly. One must see many patients who do well, and many who do less well, to learn the difference. One learns clinical judgement over time.

The wise physician interprets all data in the context of the patient history and examination. This includes lab tests, imaging studies, biopsies and prediction rules.

I will rant more on clinical judgment in the near future. This is the essence of excellence. The mystery is how we might measure it.

viagra
free viagra
buy viagra online
generic viagra
how does viagra work
cheap viagra
buy viagra
buy viagra online inurl
viagra 6 free samples
viagra online
viagra for women
viagra side effects
female viagra
natural viagra
online viagra
cheapest viagra prices
herbal viagra
alternative to viagra
buy generic viagra
purchase viagra online
free viagra without prescription
viagra attorneys
free viagra samples before buying
buy generic viagra cheap
viagra uk
generic viagra online
try viagra for free
generic viagra from india
fda approves viagra
free viagra sample
what is better viagra or levitra
discount generic viagra online
viagra cialis levitra
viagra dosage
viagra cheap
viagra on line
best price for viagra
free sample pack of viagra
viagra generic
viagra without prescription
discount viagra
gay viagra
mail order viagra
viagra inurl
generic viagra online paypal
generic viagra overnight
generic viagra online pharmacy
generic viagra uk
buy cheap viagra online uk
suppliers of viagra
how long does viagra last
viagra sex
generic viagra soft tabs
generic viagra 100mg
buy viagra onli
generic viagra online without prescription
viagra energy drink
cheapest uk supplier viagra
viagra cialis
generic viagra safe
viagra professional
viagra sales
viagra free trial pack
viagra lawyers
over the counter viagra
best price for generic viagra
viagra jokes
buying viagra
viagra samples
viagra sample
cialis
generic cialis
cheapest cialis
buy cialis online
buying generic cialis
cialis for order
what are the side effects of cialis
buy generic cialis
what is the generic name for cialis
cheap cialis
cialis online
buy cialis
cialis side effects
how long does cialis last
cialis forum
cialis lawyer ohio
cialis attorneys
cialis attorney columbus
cialis injury lawyer ohio
cialis injury attorney ohio
cialis injury lawyer columbus
prices cialis
cialis lawyers
viagra cialis levitra
cialis lawyer columbus
online generic cialis
daily cialis
cialis injury attorney columbus
cialis attorney ohio
cialis cost
cialis professional
cialis super active
how does cialis work
what does cialis look like
cialis drug
viagra cialis
cialis to buy new zealand
cialis without prescription
free cialis
cialis soft tabs
discount cialis
cialis generic
generic cialis from india
cheap cialis sale online
cialis daily
cialis reviews
cialis generico
how can i take cialis
cheap cialis si
cialis vs viagra
levitra
generic levitra
levitra attorneys
what is better viagra or levitra
viagra cialis levitra
levitra side effects
buy levitra
levitra online
levitra dangers
how does levitra work
levitra lawyers
what is the difference between levitra and viagra
levitra versus viagra
which works better viagra or levitra
buy levitra and overnight shipping
levitra vs viagra
canidan pharmacies levitra
how long does levitra last
viagra cialis levitra
levitra acheter
comprare levitra
levitra ohne rezept
levitra 20mg
levitra senza ricetta
cheapest generic levitra
levitra compra
cheap levitra
levitra overnight
levitra generika
levitra kaufen

Comments (1)

Couldnt you just track the judgement and the outcome? Have doctors choose for each decision they make- I think it IS/or I think it MAY BE then have the outcomes a simple yes or no. Trust me, the patients know.
In my son’s pediatric office we refuse to see one of the doctors there because she wrong 80% of the time. In a one year period, I had to come back 80% of the time with my son for additional treatment because hers did not work. I refuse to see her now.
No other doctor in the practice has made a diagnosis that forced me to come back again days later for additional help for a sickness.
Im sure doctors would like something more advanced, a way to include factors like – things the patient didnt mention and I didnt ask about and suck but you asked for an idea and mine is a start of an idea.
Isnt it also possible to make clinicians a specialty? Since it seems like a highly valuable skill – couldnt the clinician diagnose and the doctor provide care, follow-up, etc.?

Post a comment