Physician decision making

L. Snyder and A. L. Hillman. 1996. Financial incentives and physician decision making. In L. Snyder, ed., Ethical Choices Case Studies for Medical Practice. Philadelphia American College of Physicians, pp. 105-112. 

To make the process practical for community hospitals, this technology must be inexpensive and easily operated in the ED. Transmission of CT images to experienced radiologists for formal and final interpretation is essential for quality control and feedback. As a result, systems that permit remote decision-making by expert physicians reduce the manpower needed to provide acute stroke team coverage in ED without around-the-clock access to in-house stroke neurology. 

SP Curley, DP Connelly, EC Rich. Physicians use of medical knowledge resources preliminary theoretical framework and findings. Med Decision Making 10 231-241, 1990. 

I disagree strongly with the Don t ask don t tell policy. Without accurate knowledge, patients and physicians cannot make informed treatment decisions, researchers will ask the wrong questions and policymakers will implement misinformed policies. If the antidepressant effect is largely or entirely a placebo effect, it is important that we know this. If placebos can make people better, then depression can be ameliorated without reliance on drugs that have potentially serious side effects and that foster dependency. 

Each nation that has implemented universal health insurance has created its system in the context of cultural, political, and economic values. The values held by other advanced countries that support universal health care include a sense of national and community responsibility, social solidarity, universality, equity, acceptance of the role of government, and skepticism about markets in addressing social and human needs. Political and economic values shape the administrative and financial dimensions of their health systems. As a result, each system is unique in its balance of central and local decision-making, the power and role of hospitals and physicians, and the extent to which market forces allocate resources. 

Another critical piece in this puzzle of clinical candidate decision making is whether the drug has a good competitive advantage against existing treatment, or potentially even better, if it is first in class. Apart from the obvious reason that it is usually—but not always—better to be first and be established in the market first, there is the other reason that most overworked physicians—with medical school decades behind... 

Ultimately, your physician will make the decision as to which drug or drugs might be best for you, at least to start with. If you have a good relationship with him or her—as you should have, for heaven s sake—you can experiment until you find the winning combination. 

Never forget that you are in partnership with your physician, that you have a say in the decision-making process, and that ultimately you will play a major role in your own health destiny. It is ironic that people will be more selective in choosing an auto mechanic than a physician You owe it to yourself and your loved ones to find a doctor with whom you can establish an excellent personal relationship. Does your doctor fully answer your questions, consider your special needs and problems, and leave you with a sense of confidence If not, find another doctor If you have hypertension, controlling that condition will be a lifelong endeavor. And if you require antihypertensive drugs, a great deal of effort will... 

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