Decision Analysis by jcgx0jT


									Decision analysis.

Putting theory into practice
  Objectives of these sessions
• To help you to understand how decisions
  are made in general practice
• To help you to become more confident in
  your decision making processes
• To gain an insight into the ethics behind
  decision making
      While remembering.....

Popper invokes Immanuel Kant and his doctrine of autonomy:
[This is] the doctrine that we cannot accept the command of an
   authority, however exalted, as the ultimate basis of ethics. For
   whenever we are faced with a command by an authority, it is
   our responsibility to judge whether this command is moral or
Where does this leave the quality and outcomes framework?
In 1784 Kant wrote, in his essay "What is Enlightenment?":
   "Sapere aude! Dare to use your own intelligence! This is the
   battle cry of the Enlightenment." It should also be the battle cry
   of every clinician.
Cite this as: BMJ 2008;337:a1319

-   See “The problem with usual care” and “The road to hell....” in
     ‘resources’ in 2 slides time.
 Practice based study groups to investigate
          how decisions are made
• Explore the development of and use of NICE guidelines
• Find out about any other guidelines that are used in
  primary care e.g. BTS/SIGN
• Explore the development of and use of PCT guidelines
• Explore the development of and use of practice
  policies/guidelines (collect these and take them to your
  meetings n.b. some did this when we looked at repeat
  prescribing previously)
• Investigate the ethics of decision making, considering
  the needs and wishes of individual patients, society
  (including health care economics), doctors (and their
  potential biases)
      Some possible resources
• Journal articles (The first two are well worth a read)
1. Life and Death: The road to hell . . . Iona Heath
   BMJ 2007;335:1185,
2. The problem with usual care David Mant BJGP
   November 2008, pp. 755-756(2)
3. Decision making, evidence, audit and education: case
   study of antibiotic prescribing in general practice.
   Lipman T, Price D. BMJ;320:1114-8
4. Moving forward on rationing BMJ 18 Oct 2008 p903-
   906 a series of 3 articles looking at a clinical view, an
   ethical perspective and an economic view
      Some possible resources
• Practice based guidelines from all of your practices
  (make sure you bring these along from your practices)
• PCT guidelines (e.g. recent one on antibiotic prescribing)
  (make sure you bring these along from your practices)
• Web based material about NICE (find out how the NICE
  process works)
• See Educational material section on VTS website (Decision analysis
  another viewpoint June 2007 and Decision analysis Nov
After the practice based group work
• In the ensuing week, please consider
  recent cases where you have made
  decisions (use CbDs if you cannot think of
  others). Choose a mix of straight-forwards
  to difficult)
When we meet for review at the VTS the
following week, we plan to do the following:
In small groups look at the issues that you bring up about:

   a. the group tasks
   b. the examples of decisions you have made in the ensuing week

In the large group have an interactive session illustrating ideas around
    decision making. This might include looking at pros and cons of
    using concepts such as ‘non decision making’, using ‘time as a tool’
    the rule of 3’s, predictive values etc. etc
We might look at the factors that underpin decisions regarding whether
    or not to make referrals to hospital or outpatients etc. We could also
    look at decisions to seek a second opinion from your trainer (If we
    are all feeling brave enough)

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