Contextualizing medical decisions to individualize care - Lessons from the qualitative sciences
Contextualizing medical decisions to individualize care - Lessons from the qualitative sciences
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DOI：
10.1111/j.1525-1497.2004.30261.x
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发表时间：
2004-03-01
影响因子：
5.7
通讯作者：
Weiner, SJ
中科院分区：
文献类型：
--
作者：
Weiner, SJ
临床决策可以被描述为回答一个问题：“此时对这个病人来说，下一步最好的事情是什么？”“除了结合临床信息，研究证据和患者偏好外，该过程还需要考虑每个患者独有的与其护理相关的背景因素。不这样做，从而损害了护理，可以被称为“上下文错误”。虽然循证临床决策的支持者和许多医学访谈学者强调个性化护理的重要性，但没有为这一概念提供操作定义，也没有提出任何方法来解释临床相关的患者特异性变量。通过概念化的医生，病人遇到一个参与者，观察者的案例研究，N为1，本文介绍了如何现有的方法来研究社会系统可以为临床医生提供一个系统的方法来个性化他们的临床决策。
Clinical decision making can be described as answering one question: "What is the best next thing for this patient at this time?" In addition to incorporating clinical information, research evidence, and patient preferences, the process requires considering contextual factors that are unique to each patient and relevant to their care. The failure to do so, thereby compromising that care, can be called a "contextual error." Although proponents of evidence-based clinical decision making and many scholars of the medical interview emphasize the importance of individualizing care, no operational definition is provided for the concept, nor is any methodology proposed for the interpretation of clinically relevant patient-specific variables. By conceptualizing the physician-patient encounter as a participant-observer case study with an N of 1, this essay describes how existing approaches to studying social systems can provide clinicians with a systematic approach to individualizing their clinical decision making.