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Learning Clinical Reasoning uses a case-based approach to teach
students the basics of clinical reasoning. The first section
explains the chief components of the clinical reasoning process,
such as generating and refining diagnostic hypotheses, using and
interpreting diagnostic tests, assembling a working diagnosis,
therapeutic decision making, and examining and applying evidence,
and also includes a discussion of cognitive errors. The second
section contains 69 cases in which clinicians "think out loud"
about diagnostic and therapeutic dilemmas, and the authors critique
these clinicians' reasoning. This edition has thirty new cases from
the New England Journal of Medicine and other sources and expanded
discussions of evidence-based medicine, clinical practice
guidelines, and cognitive errors. A companion Website includes
fully searchable text, references, and a "Pattern Recognition"
section similar to Images in Clinical Medicine in NEJM.
Decision making in health care involves consideration of a complex
set of diagnostic, therapeutic and prognostic uncertainties.
Medical therapies have side effects, surgical interventions may
lead to complications, and diagnostic tests can produce misleading
results. Furthermore, patient values and service costs must be
considered. Decisions in clinical and health policy require careful
weighing of risks and benefits and are commonly a trade-off of
competing objectives: maximizing quality of life vs maximizing life
expectancy vs minimizing the resources required. This text takes a
proactive, systematic and rational approach to medical decision
making. It covers decision trees, Bayesian revision, receiver
operating characteristic curves, and cost-effectiveness analysis;
as well as advanced topics such as Markov models, microsimulation,
probabilistic sensitivity analysis and value of information
analysis. It provides an essential resource for trainees and
researchers involved in medical decision modelling, evidence-based
medicine, clinical epidemiology, comparative effectiveness, public
health, health economics, and health technology assessment.
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