>>it would be remiss of me not to share this scintilllating
talk by Prof Pat Croskerry, Professor in Emergency Medicine at Dalhousie
University, Halifax, Nova Scotia on the subject of clinical decision making and
diagnostic error.
Thanks Ash.
Actually the importance of this applies to
all decision making of course, not just the diagnostic process. We see it all
the time in decisions about prescribing decisions.If the group will indulge me
a little, take this example:-
We’ve had a paper describing this
NSAIDs case study accepted. This variation in clinical care is of course well
described and Ash, Muir Gray and others have in recent month published an NHS
Atlas of variation http://www.rightcare.nhs.uk/atlas/
Where does decision making come in? Well,
are
What I am convinced of is that simply
teaching EBM skills and producing volumes of guidelines are necessary but not
sufficient, and we also need to teach people about how they make decisions if
we are to help people to change practice in the light of new evidence. We had
several hours going over the NSAID data one day in the summer of 2007. After
all the slides had been presented and the discussion completed, I still needed
to sit on my own for at least half an hour going backwards and forwards looking
at the evidence and the prescribing data to overcome my ingrained thinking
which was screaming at me “That can’t possibly be true, can it?”.
Changing what we’ve routinely prescribed for yeas is very hard. Helping
people do that is very important.
[On a
personal note, I had orthpoaedic surgery last month at a national centre of
excellence. I’m sure the surgery was indeed excellent, time will tell. But
my cocktail of medicines for pain relief on discharge (not discussed with me at
all) included a month of diclofenac at maximum dose. Our current health secretary
espouses as part of the current NHS reforms an approach to patient involvement
in decision making as “No decision about me without me”. There is
some way to go, clearly.]
We had Pat Croskerry over a year ago and
he features in the individual decision making section of our previously trailed
film which is again here:-
Low resolution
version |
High resolution
version |
Duration (m,s) |
Introduction (11,540KB) |
Introduction (26,474KB) |
2:04 |
Evidence-based
medicine (49,223KB) |
Evidence-based
medicine (114,172KB) |
9:15 |
Information
mastery (58,780KB) |
Information
mastery (136,627KB) |
13:05 |
Individual
decision making
(71,763KB) |
Individual
decision making
(166,447KB) |
13:30 |
Group
decision making (35,940KB) |
Group
decision making
(82,721KB) |
7:45 |
Patient
decision aids (32,261KB) |
Patient
decision aids (76,016KB) |
6:16 |
Summary
and credits (22,424KB) |
Summary
and credits (51,336KB) |
5:25 |
I agree, he’s a complete star. Decision
making is the most important topic, way more important than everything else
including even EBM, in medicine, nursing, pharmacy………………
Best wishes
Neal
Neal Maskrey
National Prescribing Centre,