Teaching practical wisdom in medicine through clinical judgement, goals of care, and ethical reasoning
Teaching practical wisdom in medicine through clinical judgement, goals of care, and ethical reasoning
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DOI：
10.1136/jme.2009.035295
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发表时间：
2010-09-01
影响因子：
4.1
通讯作者：
Kaldjian, Lauris Christopher
中科院分区：
文献类型：
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作者：
Kaldjian, Lauris Christopher
临床决策是一项具有挑战性的任务，需要实践智慧——帮助患者在可用的诊断和治疗方案中做出明智选择的实践能力。但实践智慧并不是人们在医学培训和实践中通常听到的概念。相反，重点放在临床判断上。作者借鉴亚里士多德和阿奎那的思想来描述实践智慧的美德，并将其与临床判断进行比较。通过这种比较，作者认为，对临床判断的更全面的理解需要将其与护理目标和伦理价值观明确结合起来。尽管临床医生可能有理由假设护理目标和道德价值观隐含在日常决策中，但出于培训目的，鼓励有意识地以目标为导向和道德知情的临床判断习惯仍然很重要。通过将临床判断与患者的目标和价值观联系起来，临床决策更有可能关注个体患者的特殊利益。为了培养学员明智的临床判断，教育工作应旨在整合临床判断、与患者就护理目标进行沟通以及伦理推理。但最终，明智的临床判断力的培训需要在经验丰富的临床医生的陪伴下进行多年的实践，他们能够通过实例展示实践智慧。通过帮助学员发展结合患者护理目标和道德推理的临床判断，我们可以帮助降低“临床判断”仅表达“临床医生的判断”的风险。
Clinical decision making is a challenging task that requires practical wisdom-the practised ability to help patients choose wisely among available diagnostic and treatment options. But practical wisdom is not a concept one typically hears mentioned in medical training and practice. Instead, emphasis is placed on clinical judgement. The author draws from Aristotle and Aquinas to describe the virtue of practical wisdom and compare it with clinical judgement. From this comparison, the author suggests that a more complete understanding of clinical judgement requires its explicit integration with goals of care and ethical values. Although clinicians may be justified in assuming that goals of care and ethical values are implicit in routine decision making, it remains important for training purposes to encourage habits of clinical judgement that are consciously goal-directed and ethically informed. By connecting clinical judgement to patients' goals and values, clinical decisions are more likely to stay focused on the particular interests of individual patients. To cultivate wise clinical judgement among trainees, educational efforts should aim at the integration of clinical judgement, communication with patients about goals of care, and ethical reasoning. But ultimately, training in wise clinical judgement will take years of practice in the company of experienced clinicians who are able to demonstrate practical wisdom by example. By helping trainees develop clinical judgement that incorporates patients' goals of care and ethical reasoning, we may help lessen the risk that 'clinical judgement' will merely express 'the clinician's judgement.'