Goals
• Explore the ways that doctors make decisions
• See how the application of “evidence-based medicine” affected, affects and will affect medical decision-making
“goals”
• Get you excited about studying medicine
• Get you comfortable with the idea that you can study medicine, if …
“goals”
• Get you excited about studying medicine
• Get you comfortable with the idea that you can study medicine
• Get you to think broadly, expansively, daringly, insightfully about medicine
“goals”
• Get you excited about studying medicine
• Get you comfortable with the idea that you can study medicine
• Get you to think broadly, expansively, daringly, insightfully about medicine
• Get you to be a “Heretic”
Heretic
• Teacher-student Colleague-mentor
• Pre-med Medicine
• “Rememberer” Efficient data gatherer-applier
Heretic
• Teacher-student Colleague-mentor
• Pre-med Medicine
• “Rememberer” Efficient data gatherer-applier
• Health care provider
Heretic
• Teacher-student Colleague-mentor
• Pre-med Medicine
• “Rememberer” Efficient data gatherer-applier
• Health care provider Patient partner
Heretic
• Teacher-student Colleague-mentor
• Pre-med Medicine
• “Rememberer” Efficient data gatherer-applier
• Health care provider Patient partner
Heretic
• Teacher-student Colleague-mentor
• Pre-med Medicine
• “Rememberer” Efficient data gatherer-applier
• Health care provider Patient partner
• My patient
Heretic
• Teacher-student Colleague-mentor
• Pre-med Medicine
• “Rememberer” Efficient data gatherer-applier
• Health care provider Patient partner
• My patient Our patients
Heretic
• Teacher-student Colleague-mentor
• Pre-med Medicine
• “Rememberer” Efficient data gatherer-applier
• Health care provider Patient partner
• My patient Our patients
• Doctor for 2008
Heretic
• Teacher-student Colleague-mentor
• Pre-med Medicine
• “Rememberer” Efficient data gatherer-applier
• Health care provider Patient partner
• My patient Our patients
• Doctor for 2008 Doctor for 2028 …
Heretic
• Teacher-student Colleague-mentor
• Pre-med Medicine
• “Rememberer” Efficient data gatherer-applier
• Health care provider Patient partner
• My patient Our patients
• Doctor for 2008 Doctor for 2028 and Beyond!
Why Go to a Doctor?
• Solve an acute problem
• Manage a chronic problem
• Screen for disease to treat at earliest time
best chance of cure????
Why Go to a Doctor?
• Solve an acute problem
• Manage a chronic problem
• Screen for disease to treat at earliest time
best chance of cure????
• Advise on changing lifestyle issues
Different Goals
MD Goals Patient Goals
Outcome (+)/optimal Get better … optimal
Dx and Tx “correct” Feel better
Quick Quick
Paid Cheap
Learn for future patients Am I going to get better? When?
Sources of Diagnostic Data
Symptoms (hx) = patient reports
Signs (px) = examiner observes
Investigations = lab, radiology, …
Nuances of Data Collection
• Open versus Closed
• Narrative versus Directed
• History versus Physical versus Investigations
Categorization (yes / no)
Interobserver reliability: Kappa
Information Resources
• Experience
• Teachers/Training
• Books
• “The Literature”
• 4 S organization of evidence
Thinking Like a Doc ≠ Science
Science Medicine
Synthetically vs. Analytically
forward vs. backward
cause outcome vs. outcome cause
Thinking Like a Doc ≠ Science
Science/Synthetically/Forward/Cause to Outcome
• car out of gas on railroad crossing train wreck
• Etiologies Pathology
Medicine/Analytical/Backward/Outcome to Cause
• train wreck car out of gas on railroad crossing
• Pathology Etiology (fixable?)