Skip to main content

Therapeutic Decision-Making

Rationale

Internists are responsible for directing and coordinating the therapeutic management of patients with a wide variety of problems, including critically ill patients with complex medical problems and the chronically ill. To manage patients effectively, physicians need basic therapeutic decision-making skills that incorporate both pathophysiologic reasoning and evidence-based knowledge.

Prerequisites

Courses in clinical epidemiology, physiology, pathology, and pharmacology.

Specific Learning Objectives

  1. Knowledge: Each student should be able to describe:
    1. information resources for determining medical and surgical treatment options for patients with common and uncommon medical problems.
    2. key factors to consider in choosing among treatment options, including risk, cost, evidence about efficacy, and consistency with pathophysiologic reasoning.
    3. how to use critical pathways and clinical practice guidelines to help guide therapeutic decision making.
    4. factors that frequently alter the effects of medications, including drug interactions and compliance problems.
    5. factors to consider in selecting a medication from within a class of medication.
    6. factors to consider in monitoring a patient’s response to treatment, including potential adverse effects.
    7. various ways that evidence about clinical effectiveness is presented to clinicians and the potential biases of using absolute or relative risk or number of patients needed to treat.
    8. methods of monitoring therapy and how to communicate them in both written and oral form.
  2. Skills: Each student should be able to:
    1. formulate an initial therapeutic plan.
    2. access and utilize, when appropriate, information resources to help develop an appropriate and timely therapeutic plan.
    3. explain the extent to which the therapeutic plan is based on pathophysiologic reasoning and scientific evidence of effectiveness.
    4. begin to estimate the probability that a therapeutic plan will produce the desired outcome.
    5. write prescriptions accurately.
    6. counsel patients about how to take their medications and what to expect when they take their medications, including beneficial outcomes and potential adverse effects.
    7. monitor response to therapy.
  3. Attitudes: Each student should:
    1. incorporate the patient in therapeutic decision-making, explaining the risks and benefits of treatment.
    2. respect patient’s informed choices, including the right to refuse treatment.
    3. incorporate the elements of patient autonomy, treatment efficacy, quality of life, and societal demands into decision-making.
    4. provide close follow-up of patients under care.