Introduction
Moira Stewart, Judith Belle Brown, W Wayne Weston, Ian R McWhinney, Carol L McWilliam, Thomas R Freeman in Patient-Centered Medicine, 2013
The central tenet of the shared decision-making framework is that power must be more equally shared between patient and practitioner, and we agree (Légaré et al., 2003, 2010; Elwyn et al., 2012; Stiggelbout et al., 2012). Shared decision making and the patient-centered clinical method are most aligned in Component 3, “Finding Common Ground.” The approaches are most different in the following three aspects. First. the patient-centered clinical method stresses an emotional engagement with the patient that goes beyond sharing information about experiences, beliefs, and values. Second, the patient-centered clinical method stresses the need for a unique approach to each patient, and even each visit with each patient, using the structure as a guide only, with the main injunction being to follow the patient’s lead. The shared decision-making approach, while similar in its attempt to balance the formulaic and the idiosyncratic, has chosen a more standardized approach. Further, its goal is to increase shared decision making. Third, the patient-centered clinical method seeks to integrate its approach into clinical practice, hence its name as a clinical method.
Uses of the Model
Peter Worrall, Adrian French, Les Ashton, Justin Allen in Advanced Consulting In Family Medicine, 2018
Despite promotion over many years, it would appear that a patient-centred approach is not deeply embedded in professional practice, particularly at the level of the shared decision making advocated by Elwyn1 and others.2,3 Why is this? To speculate, is it possible that family doctors in training are not intellectually prepared for this change of emphasis? To explore the point, doctors leave medical school with clinical method deeply ingrained in their professional behaviour. It is essential; indeed, it is the default mode: history-taking, examination, diagnosis, management – a rational linear process. As such, clinical method is a complicated process in the sense that each stage can be isolated and improved in such a way that the overall outcome may be improved – it’s scientific and safe.
An Integrative Approach to Gender-Specific Disease
Mary Ann G. Cutter in The Ethics of Gender-Specific Disease, 2012
The descriptive and prescriptive forces in gender-specific medicine are nested in particular contexts and framed in terms of individual, communal, and societal goals. These goals turn on the rules of evidence and inference accepted by those working in particular communities. In gender-specific medicine, the rules often relate to how one weighs the outcomes of a process that have been brought to the attention of health care professionals and the capacity to control the problematic process experienced by a patient or group of patients against the harms that may be brought about by not acknowledging the process and not administering treatment. Such rules of evidence and inference evolve and change with new knowledge and technology and the recognition of previously unrecognized valued and disvalued states of affairs. The rules of evidence and inference depend not only on the methodological assumptions of the clinical method but on socio-economic factors. In this way, gender-specific disease is a trans-global concept.
A meta-analytic perspective on the valid use of subjective human judgement to make medical school admission decisions
Published in Medical Education Online, 2018
Clare Kreiter, Marie O’Shea, Catherine Bruen, Paul Murphy, Teresa Pawlikowska
When employing the clinical method, experts typically view a wide array of information about an object or individual before making a decision. For example, an investment consultant might examine and weigh economic conditions, stock valuations, technical reports, market histories and other data before recommending the purchase of a stock. In a similar fashion, physicians often subjectively weigh and combine multiple sources of information about a patient before making a diagnosis. The holistic review of medical school applicants uses the clinical method to make admission decisions. The holistic review uses human judges or committee members to evaluate and combine applicant information contained in the applicant’s file to make a decision about the applicant. In contrast, the mechanical method statistically weights the codified applicant information. The clinical method and the mechanical method have been compared in dozens of studies investigating the quality of decisions in many different contexts. While academic medical school admission is our primary focus, the strong generalizability of findings comparing the methods across applications suggests a review across contexts will be useful for understanding the clinical method’s (holistic review) application in medical education. Table 3 provides a meta-analytic summary of the research comparing the holistic/clinical method with the mechanistic/formulistic approach.
Clinician–patient relationships after two decades of a paradigm of patient-centered care
Published in International Journal of Healthcare Management, 2021
Riaz Akseer, Maureen Connolly, Jarold Cosby, Gail Frost, Rajwin Raja Kanagarajah, Swee-Hua Erin Lim
The patient-centered clinical method allows physicians to listen to a patient’s stories and explore a patient’s experience of illness. Physicians enter the patient’s world and grasp the uniqueness of the patient’s experience of illness, and understanding of what illness means for them (i.e. emotions, feelings, beliefs, expectations, goals and barriers) in order to effectively provide diagnosis and treatment, leading to better clinical outcomes [6,24,25]. Patient-centeredness as an approach strongly supports individualistically oriented Western cultural views where patients actively participate in a diagnostic interview, establish a mutually respectful working relationship with their physician and participate in joint decision-making, all of which can be adopted if the interactions are indeed reciprocal and mutual. This approach does not seem to be equally effective in communicating with patients from non-Western cultures. Studies such as the one by Kim, Smith and Yueguo [26] support a decision-making process based on a patient’s preference as a preferred method for physician interaction with patients from non-Western cultures.
An update on heart disease risk associated with testosterone boosting medications
Published in Expert Opinion on Drug Safety, 2019
G Corona, G Rastrelli, F Guaraldi, G Tortorici, Y Reismann, A Sforza, M Maggi
RCTs are usually referred to as the best clinical method for investigating the effect of a specific treatment. We previously reported that TRT was effective in men with chronic stable angina, as they had greater angina-free exercise tolerance than placebo-treated controls [29]. We now confirmed this finding in a larger number of subjects. The mechanism(s) through which TRT can improve angina symptoms has not been completely clarified. Webb et al. [78], previously reported that short-term intracoronary administration of T, at physiological concentrations, leads to a coronary artery dilatation and increases coronary blood flow in men with established CAD. Accordingly, it has been reported that T and its active metabolite, dihydrotestosterone (DHT), are able to stimulate nitric oxide release in human arterial cells in a dose-dependent manner through the activation of PI3k/Akt and ERK 1/2 pathways [79]. In addition, T acts as both an L-calcium channel blocker and potassium channel opener in vascular smooth muscle cells at the Nifedpine binding site [80–83].
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