Theory and practice of making difficult clinical decisions

doi:10.1136/bmj.38975.473889.68

BMJ 2006;333:694 (30 September), doi:10.1136/bmj.38975.473889.68

Commentary

Theory and practice of making difficult clinical decisions

Ed Peile, head of institute¹

¹ Institute of Clinical Education, Warwick Medical School, University of Warwick, Coventry CV4 7AL ed.peile@warwick.ac.uk

The first 150 words of the full text of this article appear below.

The student patient described in this report excited widespreadinterest in the medical community.¹ As well as heartfelt sympathyfor the patient and her family over this crisis, respondentshave expressed empathy for the clinical team faced with thedilemma of offering best care. Some interesting threads haveemerged in the correspondence.²

Doctors of many disciplines have modelled their thinking processes,and there are some wonderful examples of clinical reasoning.From the start, a majority of readers were highlighting theprobability of adult onset Still's disease, but, as at the bedside,the twists and turns of clinical progression forced carefulreconsideration. There was full endorsement of the decisionto get a second opinion, and the value of multiple perspectiveswas mirrored in the wisdom of medical microbiologists, rheumatologists,and generalists in the web responses.² The importance of optimalcommunication with the patient and her family amid the uncertaintywas lost . . . [Full text of this article]