Clinical inertia: a critique of medical reason

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Автор: Gérard Reach; Claudia Ratti

Название: Clinical inertia: a critique of medical reason

Язык: английский

Издательство: Cham: Springer

Год: 2014

Формат: pdf

Размер: 15,2 mb

Страниц: xxii, 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. This book proposes a critique of medical reason that may help to reconcile the principles of evidence-based medicine and individual practice.

1 Introduction

Four Perspectives

References

2 Definitions

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