Clinical decision making: promoting the jump from theory to practice

Article Abstract:

As the science of medicine has grown, the amount of knowledge that is available to the physician has similarly accumulated. The January 12, 1990 Journal of the American Medical Association has developed a new column entitled "Clinical Decision Making: From Theory to Practice" in response to this problem. Technological innovations have created vast amounts of diagnostic and therapeutic options that are available to the physician. This new section has been designed to assist the professional in developing formal approaches when examining clinical problems. A variety of different ways of approaching these problems are discussed. The inclusion of qualitative issues should be stressed equally with quantitative considerations when making diagnostic and therapeutic decisions. When treating a patient, efforts should be made to achieve a broad scope of comparative viewpoints before making clinical decisions. It is also suggested that the yield, efficacy, and priority of different approaches be examined. These suggestions are designed to augment, but not to replace traditional methods of developing clinical judgement. The new column has been created to encourage questions and stimulate debate, as well as to provide suggestions to improve clinical practice.

Methods, Management, Diagnosis, Diagnosis, Differential, Differential diagnosis

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The failure of organized health system reform - now what? Caveat aeger - let the patient beware

Article Abstract:

Physicians must favor professionalism over business and sacrifice self-interest to serve the poor in the era of health care reform. Although government-sponsored health care reform was unsuccessful in 1994, market-based reform is underway. Health care reform in 1995 is likely to improve disease prevention, strengthen primary care, control costs and limit professional liability. Reforms may negatively affect access to care and patient and physician autonomy, and may increase administrative burdens. These and other quality indicators must be monitored as reforms take shape. Significant changes in the health care system must not compromise professionalism in medicine. Physicians are duty-bound to serve the poor without financial expectations. They must balance professionalism with business interests as economic incentives and government regulation transform medicine.

Editorial, Forecasts and trends, Health care reform

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Fifty hours for the poor

Article Abstract:

The professional occupations have historically included doctors, lawyers and the clergy. They have traditionally been separated from the trades and from other business pursuits by the dedication of their members to serving the public interest. Often, the privilege to practice one's profession has been linked with the obligation to render assistance without regard for compensation. The original code of ethics of the American Medical Association states clearly that relief of pain and disease should be rendered to the poor "cheerfully and freely". Professionals such as lawyers and doctors have benefited from their opportunities, and the authors suggest that they should as a matter of principle return an appropriate amount of service to the community. At minimum, the authors conclude, one week per year should be set aside for such service.

Health aspects, Interpretation and construction, Poor, Medical ethics

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