Document Detail


The necessity for clinical reasoning in the era of evidence-based medicine.
MedLine Citation:
PMID:  24079680     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Clinical decisions are increasingly driven by evidence-based recommendations of guideline groups, which aim to be based on the highest quality knowledge-randomized clinical trials (RCTs) and meta-analyses. Although RCTs provide the best assessment of the overall value of a therapy, high-quality evidence from RCTs is often incomplete, contradictory, or absent even in areas that have been most exhaustively studied. Moreover, the likelihood of the success or failure of a therapy is not identical in all the individuals treated in any trial because therapy is not the only determinant of outcome. Therefore, the overall results of a trial cannot be assumed to apply to any particular individual, not even someone who corresponds to all the entry criteria for the trial. In addition, the potential for bias due to financial conflicts remains in many guideline groups. Guidelines are key sources of knowledge. Nevertheless, limitations in the extent, quality, generalizability, and transferability of evidence mean that we clinicians must still reason through the best choices for an individual because even in the absence of full and secure knowledge, clinical decisions must still be made. Clinical reasoning is the pragmatic, tried-and-true process of expert clinical problem solving that does value mechanistic reasoning and clinical experience as well as RCTs and observational studies. Clinicians must continue to value clinical reasoning if our aim is the best clinical care for all the individuals we treat.
Authors:
Allan D Sniderman; Kevin J LaChapelle; Nikodem A Rachon; Curt D Furberg
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Mayo Clinic proceedings     Volume:  88     ISSN:  1942-5546     ISO Abbreviation:  Mayo Clin. Proc.     Publication Date:  2013 Oct 
Date Detail:
Created Date:  2013-10-01     Completed Date:  2013-12-11     Revised Date:  2013-12-13    
Medline Journal Info:
Nlm Unique ID:  0405543     Medline TA:  Mayo Clin Proc     Country:  England    
Other Details:
Languages:  eng     Pagination:  1108-14     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2013 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Clinical Competence*
Decision Making
Evidence-Based Medicine / methods,  standards*
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use
Judgment
Practice Guidelines as Topic / standards*
Randomized Controlled Trials as Topic / methods,  standards*
Chemical
Reg. No./Substance:
0/Hydroxymethylglutaryl-CoA Reductase Inhibitors
Comments/Corrections
Comment In:
Mayo Clin Proc. 2013 Oct;88(10):1042-5   [PMID:  24079675 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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