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