Yes,
check with the group at University of Western Ontario, London, On, CANADA.
I'd start with:
Drs. Moira Stewart and Judith Belle Brown
Fred Tudiver
Fred Tudiver, MD, CCFP, FCFP
Director, Center for Evidence Based Practice
Dept. Family Medicine
SUNY Health Science Center at Syracuse
Syracuse, NY 13210
315-464-7026
[log in to unmask]
>>> "Montori, Victor M., M.D." <[log in to unmask]> 09/28 10:26 AM
>>>
Dear friends,
This is of great interest to me. In our training program we have stumbled
across the need to help our internal medicine residents with the
"second-half" of the clinical interview: that in which physician and
patient
negotiate diagnostic and therapeutic options. Core competencies are not
well
defined (see article regarding the development of partnership in BMJ two
weeks ago) and there are no established evaluation criteria. I am aware of
some tools to assess difficult decisions but that is about it.
Does anyone in the list have ideas regarding how to teach these skills
beyond modeling? In our brainstorming sessions we have explored videos of
patient encounters (or medical TV series portraying those decisions),
literature pieces for analysis (in a narrative-based medicine fashion) and
role play. We have devised a evaluation model using taped interviews with
a
simulated patient evaluated by patients, patient educators and physicians
perceived by patients to be good communicators. Is this a good model? Are
there any validated approaches? Are we trying to reinvent the wheel?
Thanks
Victor Montori, MD
-----Original Message-----
From: Djulbegovic, Benjamin [mailto:[log in to unmask]]
Sent: Tuesday, September 28, 1999 8:36 AM
To: 'Guthrie, Dr Bruce'; [log in to unmask]
Subject: RE: deciding if decision analysis is good
Bruce:
I also don't make decisions in either my everyday or professional
life by creating a decision tree, calculating probabilities for
each
branch and then assigning utilities to each outcome either on a
0-100
scale or by standard gamble (I've never tried administering them
but
when I try to do them myself, I have enormous difficulty getting my
head round them). Changing the way I make or negotiate clinical
decisions would require considerable effort and there is likely to
be
an associated time cost.
Before doing this, I would want some kind of empirical evidence
that DA is better than me trying to tell the patient the gist of
the
probabilities and trying to guage what their values are by 'normal'
consultation methods (talk, leaflets, time to think, agreeing to
defer the subject for six months, agreeing that they try
alternatives
first etc). This comes back to my original question as to how you
might judge which decision making method is 'better'. It sounds
like
either there isn't a simple answer to this, or that there isn't
research evidence directly addressing the issue.
I would again agree with you that it is not clear how to define
"gold standard" of decision-making. I would also reiterate that is
interesting to note that people may accept normative basis of EBM but not
that of decision analysis.
ben
Benjamin Djulbegovic, MD
Associate Professor of Medicine
H. Lee Moffitt Cancer Center & Research Institute
at the University of South Florida
Division of Blood and Bone Marrow Transplant
12902 Magnolia Drive
Tampa, FL 33612
Editor: Evidence-based Oncology
e-mail:[log in to unmask]
http://www.hsc.usf.edu/~bdjulbeg/
phone:(813)979-7202
fax:(813)979-3071
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