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

• 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

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?

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 Goals Patient 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?)

Valleys of Medical Education

Therapeutic Interventions

• Primum no nocere

•  

• Cost : Benefit analysis

•  

• Systems cost vs. physician's contract