Reason And Medicine

Modern medicine is one of humankind's greatest achievements.Yet today, frequent medical errors and irreproducibility in biomedical research suggest that tremendous challenges beset it. Understanding these challenges and trying to remedy them have driven considerable and thoughtful critical analyses, but the apparent intransigence of these problems suggests a different perspective is needed. Now more than ever, when we see options and opportunities for healthcare expanding while resources are diminishing, it is extremely important that healthcare professionals practice medicine wisely. In Medical Reasoning, neurologist Erwin B. Montgomery, Jr. offers a new and vital perspective. He begins with the idea that the need for certainty in medical decision-making has been the primary driving force in medical reasoning. Doctors must routinely confront countless manifestations of symptoms, diseases, or behaviors in their patients. Therefore, either there are as many different "diseases" as there are patients or some economical set of principles and facts can be combined to explain each patient's disease. The response to this epistemic conundrum has driven medicine throughout history: the challenge is to discover principles and facts and then to develop means to apply them to each unique patient in a manner that provides certainty. This book studies the nature of medical decision making systematically and rigorously in both an analytic and historical context, addressing medicine's unique need for certainty in the face of the enormous variety of diseases and in the manifestations of the same disease in different patients. The book also examines how the social, legal, and economic circumstances in which medical decision-making occurs greatly influence the nature of medical reasoning. Medical Reasoning is essential for those at the intersection of healthcare and philosophy.

Experts estimate that as many as 98,000 people die in any given year from medical errors that occur in hospitals. That's more than die from motor vehicle accidents, breast cancer, or AIDSâ€"three causes that receive far more public attention. Indeed, more people die annually from medication errors than from workplace injuries. Add the financial cost to the human tragedy, and medical error easily rises to the top ranks of urgent, widespread public problems. To Err Is Human breaks the silence that has surrounded medical errors and their consequenceâ€"but not by pointing fingers at caring health care professionals who make honest mistakes. After all, to err is human. Instead, this book sets forth a national agendaâ€"with state and local implicationsâ€"for reducing medical errors and improving patient safety through the design of a safer health system. This volume reveals the often startling statistics of medical error and the disparity between the incidence of error and public perception of it, given many patients' expectations that the medical profession always performs perfectly. A careful examination is made of how the surrounding forces of legislation, regulation, and market activity influence the quality of care provided by health care organizations and then looks at their handling of medical mistakes. Using a detailed case study, the book reviews the current understanding of why these mistakes happen. A key theme is that legitimate liability concerns discourage reporting of errorsâ€"which begs the question, "How can we learn from our mistakes?" Balancing regulatory versus market-based initiatives and public versus private efforts, the Institute of Medicine presents wide-ranging recommendations for improving patient safety, in the areas of leadership, improved data collection and analysis, and development of effective systems at the level of direct patient care. To Err Is Human asserts that the problem is not bad people in health careâ€"it is that good people are working in bad systems that need to be made safer. Comprehensive and straightforward, this book offers a clear prescription for raising the level of patient safety in American health care. It also explains how patients themselves can influence the quality of care that they receive once they check into the hospital. This book will be vitally important to federal, state, and local health policy makers and regulators, health professional licensing officials, hospital administrators, medical educators and students, health caregivers, health journalists, patient advocatesâ€"as well as patients themselves. First in a series of publications from the Quality of Health Care in America, a project initiated by the Institute of Medicine

Mastery of quality health care and patient safety begins as soon as we open the hospital doors for the first time and start acquiring practical experience. The acquisition of such experience includes much more than the development of sensorimotor skills and basic knowledge of sciences. It relies on effective reason, decision making, and communication shared by all health professionals, including physicians, nurses, dentists, pharmacists, and administrators. How to Think in Medicine, Reasoning, Decision Making, and Communications in Health Sciences is about these essential skills. It describes how physicians and health professionals reason, make decision, and practice medicine. Covering the basic considerations related to clinical and caregiver reasoning, it lays out a roadmap to help those new to health care as well as seasoned veterans overcome the complexities of working for the well-being of those who trust us with their physical and mental health. This book provides a step-by-step breakdown of the reasoning process for clinical work and clinical care. It examines both the general and medical ways of thinking, reasoning, argumentation, fact finding, and using evidence. It explores the principles of formal logic as applied to clinical problems and the use of evidence in logical reasoning. In addition to outline the fundamentals of decision making, it integrates coverage of clinical reasoning risk assessment, diagnosis, treatment, and prognosis in evidence-based medicine. Presented in four sections, this book discusses the history and position of the problem and the challenge of medical thinking; provides the philosophy interfacing topics of interest for health sciences professionals including the probabilities, uncertainties, risks, and other quantifications in health by steps of clinical work; decision making in clinical and community health care, research, and practice; Communication in clinical and community care including how to write medical articles, clinical case studies and case reporting, and oral and written communication in clinical and community practice and care.

Getting the right diagnosis is a key aspect of health care - it provides an explanation of a patient's health problem and informs subsequent health care decisions. The diagnostic process is a complex, collaborative activity that involves clinical reasoning and information gathering to determine a patient's health problem. According to Improving Diagnosis in Health Care, diagnostic errors-inaccurate or delayed diagnoses-persist throughout all settings of care and continue to harm an unacceptable number of patients. It is likely that most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences. Diagnostic errors may cause harm to patients by preventing or delaying appropriate treatment, providing unnecessary or harmful treatment, or resulting in psychological or financial repercussions. The committee concluded that improving the diagnostic process is not only possible, but also represents a moral, professional, and public health imperative. Improving Diagnosis in Health Care, a continuation of the landmark Institute of Medicine reports To Err Is Human (2000) and Crossing the Quality Chasm (2001), finds that diagnosis-and, in particular, the occurrence of diagnostic errorsâ€"has been largely unappreciated in efforts to improve the quality and safety of health care. Without a dedicated focus on improving diagnosis, diagnostic errors will likely worsen as the delivery of health care and the diagnostic process continue to increase in complexity. Just as the diagnostic process is a collaborative activity, improving diagnosis will require collaboration and a widespread commitment to change among health care professionals, health care organizations, patients and their families, researchers, and policy makers. The recommendations of Improving Diagnosis in Health Care contribute to the growing momentum for change in this crucial area of health care quality and safety.

Some people suffer from chronic, debilitating disorders for which no conventional treatment brings relief. Can marijuana ease their symptoms? Would it be breaking the law to turn to marijuana as a medication? There are few sources of objective, scientifically sound advice for people in this situation. Most books about marijuana and medicine attempt to promote the views of advocates or opponents. To fill the gap between these extremes, authors Alison Mack and Janet Joy have extracted critical findings from a recent Institute of Medicine study on this important issue, interpreting them for a general audience. Marijuana As Medicine? provides patientsâ€"as well as the people who care for themâ€"with a foundation for making decisions about their own health care. This empowering volume examines several key points, including: Whether marijuana can relieve a variety of symptoms, including pain, muscle spasticity, nausea, and appetite loss. The dangers of smoking marijuana, as well as the effects of its active chemical components on the immune system and on psychological health. The potential use of marijuana-based medications on symptoms of AIDS, cancer, multiple sclerosis, and several other specific disorders, in comparison with existing treatments. Marijuana As Medicine? introduces readers to the active compounds in marijuana. These include the principal ingredient in Marinol, a legal medication. The authors also discuss the prospects for developing other drugs derived from marijuana's active ingredients. In addition to providing an up-to-date review of the science behind the medical marijuana debate, Mack and Joy also answer common questions about the legal status of marijuana, explaining the conflict between state and federal law regarding its medical use. Intended primarily as an aid to patients and caregivers, this book objectively presents critical information so that it can be used to make responsible health care decisions. Marijuana As Medicine? will also be a valuable resource for policymakers, health care providers, patient counselors, medical faculty and studentsâ€"in short, anyone who wants to learn more about this important issue.

Mastery of quality health care and patient safety begins as soon as we open the hospital doors for the first time and start acquiring practical experience. The acquisition of such experience includes much more than the development of sensorimotor skills and basic knowledge of the sciences. It relies on effective reasoning, decision making, and communication shared by all health professionals, including physicians, nurses, dentists, pharmacists, physiotherapists, and administrators. A Primer on Clinical Experience in Medicine: Reasoning, Decision Making, and Communication in Health Sciences is about these essential skills. It describes how physicians and health professionals reason, make decisions, and practice medicine. Covering the basic considerations related to clinical and caregiver reasoning, it lays out a roadmap to help those new to health care as well as seasoned veterans overcome the complexities of working for the well-being of those who trust us with their physical, mental, and spiritual health. The book provides a step-by-step breakdown of the reasoning process for clinical work and clinical care. It examines both general and medical ways of thinking, reasoning, argumentation, fact finding, and using evidence. Outlining the fundamentals of decision making, it integrates coverage of clinical reasoning, risk assessment, diagnosis, treatment, and prognosis in evidence-based medicine. It also: Describes how to evaluate the success (effectiveness and cure) and failure (error and harm) of clinical and community actions Considers communication with patients and outlines strategies, successes, failures, and possible remedies—including offices, bedside, intervention, and care settings Examines strategies, successes, failures, and possible remedies for communication with peers—including interpersonal communication, morning reports, rounds, and research gatherings The book describes vehicles, opportunities, and environments for enhanced professional communication, including patient interviews, clinical case reports, and morning reports. It includes numerous examples that demonstrate the importance of sound reasoning, decision making, and communication and also considers future implications for research, management, planning, and evaluation.

The global popularity of herbal supplements and the promise they hold in treating various disease states has caused an unprecedented interest in understanding the molecular basis of the biological activity of traditional remedies. Herbal Medicine: Biomolecular and Clinical Aspects focuses on presenting current scientific evidence of biomolecular ef

Second in a series of publications from the Institute of Medicine's Quality of Health Care in America project Today's health care providers have more research findings and more technology available to them than ever before. Yet recent reports have raised serious doubts about the quality of health care in America. Crossing the Quality Chasm makes an urgent call for fundamental change to close the quality gap. This book recommends a sweeping redesign of the American health care system and provides overarching principles for specific direction for policymakers, health care leaders, clinicians, regulators, purchasers, and others. In this comprehensive volume the committee offers: A set of performance expectations for the 21st century health care system. A set of 10 new rules to guide patient-clinician relationships. A suggested organizing framework to better align the incentives inherent in payment and accountability with improvements in quality. Key steps to promote evidence-based practice and strengthen clinical information systems. Analyzing health care organizations as complex systems, Crossing the Quality Chasm also documents the causes of the quality gap, identifies current practices that impede quality care, and explores how systems approaches can be used to implement change.