Episode 62 Diagnostic Decision Making in Emergency Medicine

Emergency Medicine Cases

Dr. Anton Helman

Education, Health & Fitness, Courses, Medicine, Science

4.7 • 602 Ratings

🗓️ 15 April 2015

⏱️ 66 minutes

🔗️ Recording | iTunes | RSS

🧾️ Download transcript

Summary

This is Part 1 of EM Cases' series on Diagnostic Decision Making with Walter Himmel, Chris Hicks and David Dushenski discussing the intersection of evidence-based medicine, cognitive bias and systems issues to effect our diagnostic decision making in Emergency Medicine. In this episode we first discuss 5 strategies to help you master evidence-based diagnostic decision making to minimize diagnostic error, avoid over-testing and improve patient care including: 1. The incorporation of patients' values and clinical expertise into evidence-based decisions 2. Critically appraising diagnostic studies 3. Understanding that diagnostic tests are not perfect 4. Using the concept of test threshold to guide work-ups 5. Understanding that the predictive value of a test depends on the prevalence of disease We then go on to review some of the factors that play into the clinician’s and patient’s risk tolerance in a given clinical encounter, how this plays into shared decision making and the need to adjust our risk tolerance in critical situations. Finally, we present some strategies to prevent over-testing while improving patient care, patient flow and ethical practice.

Transcript

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0:00.0	Welcome to the Emergency Medicine Cases Podcast.
0:05.8	I'm your host, Dr. Anton Hellman, bringing you Canada's brightest minds in emergency medicine from EMC Studios in Toronto.
0:13.7	Walter Himmel.
0:14.8	Do not be a victim of a test.
0:18.9	Chris Hicks.
0:20.1	I don't know that science will ever eliminate bias completely.
0:25.0	And Dave Dyshensky.
0:26.8	Slavishly following anything from evidence-based medicine is a recipe to get you into trouble.
0:33.1	The test is not going to tell you if the diagnosis is, but it's going to tell you if it's more
0:36.8	likely or less likely.
0:39.5	Individual practice variation is part of what we do, and I don't know that we're ever going
0:43.7	to eliminate it.
0:45.0	So it's not some evil plot by government, by pharmaceutical companies, or by thought controllers.
0:52.4	Just before we jump into this episode on diagnostic decision making, I just want to
0:55.9	make a very quick announcement that now you can get all the podcasts, including all the main episodes
1:01.7	and best case ever as journal gems, all through iTunes. So you can use any podcast app you want
1:08.2	and get automatic downloads of all the EM cases podcast through iTunes.
1:13.5	You don't need to go to the podcast set up anymore on the website.
1:19.7	In the first part of this series of podcasts on diagnostic decision making, we're going to talk about
1:24.9	diagnostic error in terms of how best to incorporate
1:28.0	evidence-based medicine and risk tolerance into our practice so that we can make the best
1:33.1	diagnostic decisions for our patients and the medical systems we work in. Now, the first
	...

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