Methods in Medicine: A Descriptive Study of Physicians' Behaviour

ISBN-13: 9789401069847 / Angielski / Miękka / 2011 / 240 str.

J. Ridderikhoff

Opis

Clinicians spend their working lives making decisions. such decisions are usually made in interlocking streams rather than in the discrete circumscribed contexts so beloved of scientists. When the clinician encounters a patient a complex interactive process is initiated in which the clinician searches his memory to match the symptoms and signs indicated by the patient with the complex disease models which he carries in his head. He then makes choices about further questions or tests in order to clarify his understanding of the patient's problem and to formulate a management or treatment plan. In recent years there has been increasing interest in how clinicians make such decisions and a realization that decision-making in clinical medicine is virtually the same as that in many other professional contexts. The scientific study and formal teaching of clinical decision-making is a relatively young discipline. Less than 20 books have so far appeared which take explicit account of the theoretical and experimental decision-making literature in medicine and other related disciplines. This book is a distinctive and important contribution to this growing field. It combines a comprehensive critical analysis of a wide range of relevant philo sophical, statistical, psychological and medical literature with an interesting set of experimental observations of primary care physicians. Dr. Ridderikhoff shows great erudition and wide command of a large reference literature. Dr. Ridderikhoff takes a firmly descriptive rather than prescriptive viewpoint on understanding clinical decision-making.

Spis treści

I: Medical knowledge.- A historical view.- The concept of disease.- Taxonomy of diseases.- Medical data.- Reliability of data.- Data recording.- Diagnosis.- Prediction.- Treatment.- Summary.- II: Ways of reasoning.- Science and belief.- Methods in science.- Deductive reasoning.- Hypothetico-deductive reasoning.- Inductive reasoning.- Probabilistic reasoning.- Conditions for the valid application of the probability theory.- Logical implications of probability theory.- Summary.- III: Human thinking and problem-solving and their relationship to medicine.- Human cognition and the development of thought.- Problem-solving.- Thought processes.- The process of memory storage and recall.- The process of forgetting.- Problem-solving in complex tasks.- I. Restructure of the problem.- II. Limiting the information.- Studies of physicians’ thought processes.- The validity of inference.- What is a problem?.- What is a medical problem?.- Problem space and task environment.- Problem-solving processes.- The approach to problem-solving.- Studies of physicians’ problem-solving.- The validity of clinical judgements.- Summary.- IV: Clinical decision-making.- Historical background.- Towards a decision theory.- Some thoughts on utility theory.- Decision theory.- Bayes’ theorem.- Constraints on the rational decision maker.- Meeting the rational decision maker.- Artificial intelligence.- Alternative decision-making models.- Satisficing theory.- Incrementalism.- Garbage can model.- Conflict model.- Summary.- V: Models and methods.- Models in medical reasoning.- Styles of problem-solving and decision-making.- The models.- Deductive model.- Inductive model.- Hypotheses.- Subtypes of inductive reasoning.- Landmarks in the models.- Instruments.- The paper patient.- Case histories for the investigation.- Hypotheses and symptoms.- Hypotheses levels.- Observational methods.- Simulation procedure.- Summary.- VI: Results of the study.- The criteria for the strategies.- Deductive reasoning.- Inductive reasoning.- Pattern recognition.- Inductive-heuristic reasoning.- Inductive-algorithmic reasoning.- Relevancy and redundancy in information processing.- On hypotheses.- On symptoms and diagnoses.- Symptom clustering.- Decomposition procedure.- On questions, answers, and time.- Ratio effectiveness.- Content effectiveness.- Retrieval rate.- On probabilities and (un)certainties.- On patient management and therapy.- On diagnostic gradation.- On experience and consequences.- Summary.- VII: Reflections, conclusions, consequences.- The inductive method in medicine.- On the circular process.- On hypotheses.- On diagnoses.- On prognosis and treatment.- On learning and experience.- On medical research.- Closing remarks.- References.- Author index.