1. Medical Decision-Making and Clinical Research

2. Class Format 5-10 minute quiz

3. Class Format 5-10 minute quiz on readings Interactive

4. Class Format 5-10 minute quiz on readings Interactive Didactics, prn

5. Class Format 5-10 minute quiz on readings Interactive Didactics, prn Work as a group

6. Goals Explore the ways that doctors make decisions

7. Goals Explore the ways that doctors make decisions See how the application of “evidence-based medicine” affected, affects and will affect medical decision-making

8. “goals” Get you excited about studying medicine

9. “goals” Get you excited about studying medicine Get you comfortable with the idea that you can study medicine, if …

10. “goals” Get you excited about studying medicine Get you comfortable with the idea that you can study medicine Get you to think broadly, expansively, daringly, insightfully about medicine

11. “goals” Get you excited about studying medicine Get you comfortable with the idea that you can study medicine Get you to think broadly, expansively, daringly, insightfully about medicine Get you to be a “Heretic”

12. Heretic

13. Teacher-student

14. Heretic Teacher-student  Colleague-mentor

15. Heretic Teacher-student  Colleague-mentor Pre-med

16. Heretic Teacher-student  Colleague-mentor Pre-med  Medicine

17. Heretic Teacher-student  Colleague-mentor Pre-med  Medicine “Rememberer”

18. Heretic Teacher-student  Colleague-mentor Pre-med  Medicine “Rememberer”  Efficient data gatherer-applier

19. Heretic Teacher-student  Colleague-mentor Pre-med  Medicine “Rememberer”  Efficient data gatherer-applier Health care provider

20. Heretic Teacher-student  Colleague-mentor Pre-med  Medicine “Rememberer”  Efficient data gatherer-applier Health care provider  Patient partner

21. Heretic Teacher-student  Colleague-mentor Pre-med  Medicine “Rememberer”  Efficient data gatherer-applier Health care provider  Patient partner

22. Heretic Teacher-student  Colleague-mentor Pre-med  Medicine “Rememberer”  Efficient data gatherer-applier Health care provider  Patient partner My patient

23. Heretic Teacher-student  Colleague-mentor Pre-med  Medicine “Rememberer”  Efficient data gatherer-applier Health care provider  Patient partner My patient  Our patients

24. Heretic Teacher-student  Colleague-mentor Pre-med  Medicine “Rememberer”  Efficient data gatherer-applier Health care provider  Patient partner My patient  Our patients Doctor for 2008

25. Heretic Teacher-student  Colleague-mentor Pre-med  Medicine “Rememberer”  Efficient data gatherer-applier Health care provider  Patient partner My patient  Our patients Doctor for 2008  Doctor for 2028 …

26. Heretic Teacher-student  Colleague-mentor Pre-med  Medicine “Rememberer”  Efficient data gatherer-applier Health care provider  Patient partner My patient  Our patients Doctor for 2008  Doctor for 2028 and Beyond!

27. Why Go to a Doctor?

28. Solve an acute problem

29. Why Go to a Doctor? Solve an acute problem Manage a chronic problem

30. Why Go to a Doctor? Solve an acute problem Manage a chronic problem Screen for disease to treat at earliest time  best chance of cure????

31. Why Go to a Doctor? Solve an acute problem Manage a chronic problem Screen for disease to treat at earliest time  best chance of cure???? Advise on changing lifestyle issues

32. Different Goals MD GoalsPatient Goals Outcome (+)/optimalGet better … optimal Dx and Tx “correct”Feel betterQuick Paid Cheap Learn for future patientsAm I going to get better? When?

33. Sources of Diagnostic Data Symptoms (hx)=patient reports Signs (px)=examiner observes Investigations=lab, radiology, …

34. Nuances of Data Collection Open versus Closed Narrative versus Directed History versus Physical versus Investigations  Categorization (yes / no) Interobserver reliability: Kappa

35. Information Resources Experience Teachers/Training Books “The Literature” 4 S organization of evidence

37. Thinking Like a Doc ≠ Science Science Medicine Synthetically vs. Analytically forward vs. backward cause  outcomevs.outcome  cause

38. Thinking Like a Doc ≠ Science Science/Synthetically/Forward/Cause to Outcome car out of gas on railroad crossing  train wreck Etiologies  Pathology Medicine/Analytical/Backward/Outcome to Cause train wreck  car out of gas on railroad crossing Pathology  Etiology (fixable?)

39. Valleys of Medical Education

40. Therapeutic Interventions Primum no nocere Cost : Benefit analysis Systems cost vs. physician's contract