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MEDICAL DECISION MAKING
Medical decision-making is a complex skill that is slowly
acquired over the years by healthcare professionals as they deal with patients,
observe more experienced professionals and discuss their decisions and the
reasons behind making those decisions with their colleagues. 1
2
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Recently evidence-based medicine (EBM) and clinical guidelines
have been dominating medical decision making.3
The processes involved in making medical decisions are usually informal and
they are various frameworks that help to assist healthcare professionals. These
frameworks however can be reduced to four principle steps
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Identifying the problem.
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Identifying possible alternatives.
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Development of possible solutions to the problem.
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Choosing and implementing the best alternative.
There are also various programs that exist to assist in
medical decision-making. In the UK, the National
Health Service (NHS), has adopted the clinical management advice
system, PRODIGY, which was developed
by the Sowerby Centre for Health Informatics
Newcastle (SCHIN). The guidance provided by PRODIGY is maintained by
the National Institute for Clinical Excellence
(NICE). NICE is a Special Health Authority within the NHS providing guidance on
medicines, equipment, procedures and management of care.
The Society for Medical Decision
Making (SMDM) is another organisation that is involved the improvement
in the outcomes of clinical decision making and policy formation but
principally within the US.
References
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Flaherty, Robert J. [WWW] 5TH July 1999 About
Evidence-Based Medicine. http://www.montana.edu/wwwebm/AboutEBM.htm
(3RD October 2003).
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Degoulet, Practice; Fieschi, Marius. Introduction to clinical
Informatics, Chp 4. Springer 1999.
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Parker, M. Whither our art? Clinical wisdom and evidence-based
medicine. Med Health Care Philos. 2002;5(3):273-80.
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