Clinical decision making is the intersection of the science of evidence-based medicine and the art of shared decision making occurring within the bounds of the health care system (Figure 10-4). People yearn for a relationship with their physician, someone who listens to their needs and guides them through the medical system (Future of Family Medicine, 2004). Who is better equipped to perform outstanding clinical decision making and foster excellent physician-patient communication than the family physician? By forming close longitudinal relationships, family physicians have the opportunity to truly know their patients and to understand their values, their preferences, and their fears. When combined with evidence-based medical knowledge, it is no wonder patients trust and value their family physician.
*http://www.canadianstrokenetworkca/research/dincians.php. Figure 10-4 Clinical decision-making model.
The complete reference list is available online at www.expertconsult.com.
Cochrane Abstracts. Evidence-based systematic reviews of health care interventions.
Pros: Peer-reviewed evidence-based summaries.
Cons: Only abstracts available free, entire review is subscription service.
National Guidelines Clearinghouse. Evidence-based clinical practice guidelines.
Pros: Large library of clinical guidelines.
Cons: Evidence-based quality is not uniform and depends on guideline authors themselves; multiple guidelines for a single condition (e.g., hypertension yields 533 guidelines).
Up To Date. Evidence-based peer-reviewed information resource; subscription based.
Pros: Comprehensive reviews on many topics with diagnostic and treatment information.
Cons: May not contain the latest evidence; may contain expert opinion.
Family Physicians Inquiries Network. Brief, structured evidence-based answers to clinical questions; subscription based.
Pros: Succinct reviews with evidence grading.
Cons: Although library is large, the questions answered may be extremely specific.
Family Practice Notebook. Notes in outline form on a variety of topics.
Pros: Succinct information from a variety of sources.
Cons: No peer review; references may be sparse.
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