Автор: Gerard Reach; Claudia Ratti Название: Clinical Inertia: A Critique of Medical Reason Издательство: Cham: Springer Год: 2014 ISBN: 3319098810, 9783319098814 Язык: English Формат: pdf Размер: 15,2 mb Страниц: 142
Clinical practice guidelines were initially developed within the context of evidence-based medicine with the goal of putting medical research findings into practice. However, physicians do not always follow them, even when they seem to apply to the particular patient they have to treat. This phenomenon, known as clinical inertia, represents a significant obstacle to the efficiency of care and a major public health problem, the extent of which is demonstrated in this book.
An analysis of its causes shows that it stems from a discrepancy between the objective, essentially statistical nature of evidence-based medicine on the one hand and the physician’s own complex, subjective view (referred to here as “medical reason”) on the other.
Clinical Inertia Therapeutic Inertia and Clinical Inertia Clinical Practice Guidelines Evidence-Based Medicine Evidence Practice Gap Medical Error What Is Not Clinical Inertia Formal Definition of Clinical Inertia Definition: Physician Behavior Falls Under Clinical Inertia If and Only If References
3 The Evidence: The Gap Between Guidelines and Clinical Reality
Introduction: Highlighting the Existence of the Phenomenon and Its Consequences Consequences of Clinical Inertia Analysis of Clinical Inertia in Different Diseases Diabetes Hypertension Hyperlipidemia Cardiovascular Risk Prevention Other Conditions Where One Can Highlight the Clinical Inertia Phenomenon References
4 Determinants and Explanatory Models of Clinical Inertia
Determinants of Clinical Inertia Initial Explanations: Denial, Exaggerated Use of '‘Soft Reasons” and Physician Lack of Training on the Principle of Titration Competing Demands The Effect of Uncertainty Poor Appreciation of the Actual Situation of the Patient. Characteristics of the Physician The Effect of Belonging to an Ethnic Minority and Being Disadvantaged The Doctor, Her Patient and the Health Care System Physician Clinical Inertia and Patient Nonadherence Theoretical Explanatory Models of Clinical Inertia The Knowledge-Attitude-Behavior-Result Model The Awareness-Agreement-Adoption-Adherence Model A Symmetrical Model Involving Physician and Patient: The Management of Dyslipidemia in Women Physician Guideline Compliance Model Another Psychological Model Applied to Comprehension of Clinical Inertia: The Regulatory Focus Theory References
5 The Physician and Evidence-Based Medicine
A New Way to Practice Medicine Objectives of Evidence-Based Medicine Data and Guidelines: Different Levels of Evidence What Is Not Evidence-Based Medicine Evidence-Based Medicine: Clinical Practice Assisted by the Development of Clinical Practice Guidelines Evidence-Based Medicine, Medicine Practiced Within a Context of Uncertainty Evidence-Based Medicine: A Change of Paradigm? SchrOdinger’s Cat and Einstein’s Boxes A Critique of Evidence-Based Medicine The Physician Faced with a New Medicine Theoretical Critiques of Evidence-Based Medicine Epistemological Critique of the Concept of Evidence-Based Medicine From an Evidence-Based Medicine to a Practice-Based Medicine By Way of Provisional Conclusion: Guidelines or “Mindlincs"? References
6 To Do or Not to Do: A Critique of Medical Reason
Definition The Context of Uncertainty Which Surrounds All Medical Activities, and the Concept of Risk The Notion of Heuristics and Bias Different Heuristics Used in Human Judgment Within a Context of Uncertainty Sources of Bias in Decisions Under Risk Heuristics Are Necessary and Do Not Necessarily Have an Adverse Effect Heuristics, Principles of Evidence-Based Medicine, and Medical Behavior: Coming Back to Clinical Inertia Role of Emotions in Medical Decisions Emotions in Mental Life Emotions in Medical Decisions Emotions and Cognition: Two Components of Reason Emotions as Notification of the Feeling of Risk Relationship Between Emotions and Behavior: Rather Than Causation, a Feedback Dynamic Chagrin and Regret: Application to the Issue of Clinical Inertia. Emotions in the Interaction Between Physician and Patient, and in the Relationship Between Clinical Inertia and Nonadherence Or Not to Do: Psychology of the Status Quo and the Difficulty of Making a Decision References
7 Overcoming True Clinical Inertia
Education Initial Training of Physicians Continuing Medical Education Role of “Opinion Leaders” Reminder and Feedback Systems Facilitators Simplify Treatments, Use Treatments Having Fewer Side Effects Overcoming Decisional Uncertainty Through Protocols Organizational Aspects Reinforcement Incentive by Public Authorities: Pay for Performance Incentive by Patients Incentive by Others: Peers. Pharmacists and Nurses Physician Self-Incentive: An Explanation Through Philosophy of Mind Force of Habit Can One Avoid Cognitive Biases? Emotional Reversal: Using Emotions to Overcome Clinical Inertia Concern: The Philosophical Dimension of Care Implementing Positive Emotions: Emotional Reversal Physician Optimism and Pessimism Trust. Pride and Self-Approval References
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