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Harrison's Principles of Internal Medicine, 18e
| Part 1. Introduction to Clinical Medicine > |
Chapter 3. Decision-Making in Clinical Medicine
Sections: Decision-Making in Clinical Medicine: Introduction, Interpretation of Diagnostic Tests in the Context of Decision-Making, Formal Decision Support Tools, Evidence-Based Medicine, Conclusions, Further Readings.
Topics Discussed: decision making.
Excerpt:"To a medical student who requires 2 hours to collect a patient's history and perform a physical examination and several additional hours to organize that information into a coherent presentation, an experienced clinician's ability to decide on a diagnosis and management plan in a fraction of the time seems extraordinary. What separates the experienced clinician's performance from that of the novice is an elusive quality called "expertise." The first part of this chapter will provide a brief introduction to what is known about the development of expertise in clinical reasoning.It is surprisingly difficult to define clearly what is meant by "clinical expertise." Chess has its masters, music its virtuoso performers, and athletics its Olympians. But in medicine, once training is complete and the boards are passed, there are no further tests or benchmarks of performance or ability that can be used to identify those who have attained the highest level of abilities in their clinical roles. Of course, there are always a few clinicians who are believed by their colleagues to have special problem-solving abilities: the "elite" who are consulted when particularly difficult or obscure cases have baffled everyone else. But for all their expertise, such doctors typically cannot..."
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