Clinical Inertia[Recurs electrònic] : A Critique of Medical Reason

Clinical practice guidelines were initially developed within the context of evidence-based medicine with the goal of putting medical research findings into practice. However, physicians do not always follow them, even when they seem to apply to the particular patient they have to treat. This phenomenon, known as __clinical inertia,__ represents a significant obstacle to the efficiency of care and a major public health problem, the extent of which is demonstrated in this book. An analysis of its causes shows that it stems from a discrepancy between the objective, essentially statistical nature of evidence-based medicine on the one hand and the physician’s own complex, subjective view (referred to here as “medical reason”) on the other. This book proposes a __critique of medical reason__ that may help to reconcile the principles of evidence-based medicine and individual practice. The author is a diabetologist and Professor of Endocrinology, Diabetology and Metabolic Diseases at Paris 13 University. He has authored several books, including one to be published by Springer (Philosophy and Medicine series) under the title: __The Mental Mechanisms of Patient Adherence to Long Term Therapies, Mind and Care__. Clinical practice guidelines were initially developed within the context of evidence-based medicine with the goal of putting medical research findings into practice. However, physicians do not always follow them, even when they seem to apply to the particular patient they have to treat. This phenomenon, known as clinical inertia, represents a significant obstacle to the efficiency of care and a major public health problem, the extent of which is demonstrated in this book. An analysis of its causes shows that it stems from a discrepancy between the objective, essentially statistical nature of evidence-based medicine on the one hand and the physician's own complex, subjective view (referred to here as "medical reason") on the other. This book proposes a critique of medical reason that may help to reconcile the principles of evidence-based medicine and individual practice. The author is a diabetologist and Professor of Endocrinology, Diabetology and Metabolic Diseases at Paris 13 University. He has authored several books, including one to be published by Springer (Philosophy and Medicine series) under the title: The Mental Mechanisms of Patient Adherence to Long Term Therapies, Mind and Care . , Diabetology and Metabolic Diseases at the Paris 13-University. He has also published Pourquoi Se soigne-t-on, Enquête sur la rationalité morale de l'observance (2007), Clinique de l'Observance, L'Exemple des diabètes (2006), and Une théorie du soin, Souci et amour face à la maladie (2010). An English adaptation of the first book is published by Springer (Philosophy and Medicine) under the title: The Mental Mechanisms of Patient Adherence to Long Term Therapies, Mind and Care . Clinical Practice Guidelines Were Initially Developed Within The Context Of Evidence-based Medicine With The Goal Of Putting Medical Research Findings Into Practice. However, Physicians Do Not Always Follow Them, Even When They Seem To Apply To The Particular Patient They Have To Treat. This Phenomenon, Known As Clinical Inertia, Represents A Significant Obstacle To The Efficiency Of Care And A Major Public Health Problem, The Extent Of Which Is Demonstrated In This Book. An Analysis Of Its Causes Shows That It Stems From A Discrepancy Between The Objective, Essentially Statistical Nature Of Evidence-based Medicine On The One Hand And The Physician's Own Complex, Subjective View (referred To Here As Medical Reason) On The Other. This Book Proposes A Critique Of Medical Reason That May Help To Reconcile The Principles Of Evidence-based Medicine And Individual Practice. Introduction -- Definitions -- The Evidence: The Gap Between Clinical Guidelines And Reality -- Determinants And Explanatory Models Of Clinical Inertia -- The Doctor And Evidence-based Medicine -- To Do Or Not To Do: A Critique Of Medical Reason -- Fighting Against True Clinical Inertia -- Conclusion: Time For Medical Reason -- References. Gérard Reach ; Translation By Claudia Ratti. Translation From The French Language Edition L'inertie Clinique / Gérard Reach. 2013. Includes Bibliographical References And Index. Mode Of Access: World Wide Web. Clinical practice guidelines were initially developed within the context of evidence-based medicine with the goal of putting medical research findings into practice. However, physicians do not always follow them, even when they seem to apply to the particular patient they have to treat. This phenomenon, known as clinical inertia, represents a significant obstacle to the efficiency of care and a major public health problem, the extent of which is demonstrated in this book. An analysis of its causes shows that it stems from a discrepancy between the objective, essentially statistical nature of evidence-based medicine on the one hand and the physicianĺls own complex, subjective view (referred to here as ĺlmedical reasonĺl) on the other. This book proposes a critique of medical reason that may help to reconcile the principles of evidence-based medicine and individual practice. The author is a diabetologist and Professor of Endocrinology, Diabetology and Metabolic Diseases at Paris 13 University. He has authored several books, including one to be published by Springer (Philosophy and Medicine series) under the title: The Mental Mechanisms of Patient Adherence to Long Term Therapies, Mind and Care Physician Clinical Inertia and Patient Nonadherence Theoretical Explanatory Models of Clinical Inertia; The Knowledge-Attitude-Behavior-Result Model; Barriers in Knowledge; Barriers in Attitudes; Barriers in Behavior; The Awareness-Agreement-Adoption-Adherence Model; A Symmetrical Model Involving Physician and Patient: The Management of Dyslipidemia in Women; Physician Guideline Compliance Model; Another Psychological Model Applied to Comprehension of Clinical Inertia: The Regulatory Focus Theory; References; 5: The Physician and Evidence-Based Medicine; A New Way to Practice Medicine Foreword; Nonadherence by Patients; Nonadherence by Doctors; Conclusion; References; Foreword to the French Edition; References; Contents; 1: Introduction; Four Perspectives; References; 2: Definitions; Clinical Inertia; Therapeutic Inertia and Clinical Inertia; Clinical Practice Guidelines; Evidence-Based Medicine; Evidence Practice Gap; Medical Error; What Is Not Clinical Inertia; Formal Definition of Clinical Inertia; Definition: Physician Behavior Falls Under Clinical Inertia If and Only If; References; 3: The Evidence: The Gap Between Guidelines and Clinical Reality Objectives of Evidence-Based Medicine Data and Guidelines: Different Levels of Evidence; What Is Not Evidence-Based Medicine; Evidence-Based Medicine: Clinical Practice Assisted by the Development of Clinical Practice Guidelines; Clinical Practice in the Context of Evidence-Based Medicine; Clinical Practice Guidelines, Assistance in Medical Decisions in the Evidence-Based Medicine State of Mind; Evidence-Based Medicine, Medicine Practiced Within a Context of Uncertainty; Uncertainty Within the Field of Diagnosis; Bayes' Theorem; Uncertainty Within the Therapeutic Field Introduction: Highlighting the Existence of the Phenomenon and Its ConsequencesConsequences of Clinical Inertia; Analysis of Clinical Inertia in Different Diseases; Diabetes; Clinical Inertia in Hospitals; Psychological Insulin Resistance; Clinical Inertia and Monitoring of Diabetic Patients; Hypertension; Description of Barriers to Treatment Intensification in the Case of Hypertension; Hyperlipidemia; Cardiovascular Risk Prevention; Other Conditions Where One Can Highlight the Clinical Inertia Phenomenon; Heart Failure; Management of Valvular Heart Disease Complete Arrhythmia Due to Atrial FibrillationAsthma; Osteoporosis; References; 4: Determinants and Explanatory Models of Clinical Inertia; Determinants of Clinical Inertia; Initial Explanations: Denial, Exaggerated Use of "Soft Reasons" and Physician Lack of Training on the Principle of Titration; Competing Demands; The Effect of Uncertainty; Poor Appreciation of the Actual Situation of the Patient; Characteristics of the Physician; The Effect of Belonging to an Ethnic Minority and Being Disadvantaged; The Doctor, Her Patient and the Health Care System Content: Front Matter....Pages i-xxii Introduction....Pages 1-4 Definitions....Pages 5-12 The Evidence: The Gap Between Guidelines guidelines and Clinical Reality....Pages 13-30 Determinants and Explanatory Models of Clinical Inertia....Pages 31-44 The Physician and Evidence-Based Medicine....Pages 45-71 To Do or Not to Do: A Critique of Medical Reason medical reason ....Pages 73-95 Overcoming True Clinical Inertia....Pages 97-119 Conclusion: Time for Medical Reason medical reason ....Pages 121-136 Back Matter....Pages 137-142