Journal of evaluation in clinical practice
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Generalists manage a broad range of biomedical and biographical knowledge as part of each clinical encounter, often in multiple encounters over time. The sophistication of this broad integrative work is often misunderstood by those schooled in reductionist or constructivist approaches to evidence. There is a need to describe the practical and philosophically robust ways that understanding about the whole person is formed. In this paper we describe first principles of generalist approaches to knowledge formation in clinical practice. We name the Craft of Generalism. ⋯ Naming the Craft of Generalism defines the generalist gaze and protects generalism from the colonization of a narrowed medical gaze that excludes all but reductionist evidence or constructivist experience. Defining the Craft of Generalism enables clear teaching of the sophisticated skills and attitudes of the generalist clinician. These philosophically robust principles encourage and defend the use of generalist approaches to knowledge in settings across the community - including health policy, education, and research.
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Education of patients is thought to be key to high-quality oral anticoagulant (OAC) medication management. Theoretically, improving patients' knowledge should improve their self-management skills and adherence. The study's objective was to explore the opinions of healthcare providers and patients on the desired content and format of patient education on OACs, in addition to perceived barriers to high-quality patient education. ⋯ Our findings suggest that patients, caregivers and healthcare providers support the need for education on OACs, including for patients taking DOACs. Specific important content and proper education format are needed. The optimal combination of content, format, duration, timing and sources for OAC education requires further research.
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The well-known clinical axiom declaring that 'common things are common' attests to the pivotal role of probability in diagnosis. Despite the popularity of this and related axioms, there is no operationalized definition of a common disease, and no practicable way of incorporating actual disease frequencies into differential diagnosis. ⋯ We explore how numerical estimates of disease frequencies based on incidence can be incorporated into differential diagnosis as well as the inherent limitations of this method. These concepts have important implications for diagnostic decision making and medical education, and hold promise as a method to improve diagnostic accuracy.
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Medically trained health professionals have been central to the development of policy responses to the coronavirus 2019 (COVID-19) crisis. In their multiple roles-as clinicians, public health leaders, members of scientific advisory boards, and also as media pundits and health professionals-they have helped shape discourses of science-based policy options during the first 2 years of the pandemic. In particular, health professionals as a collective voice insisted on the necessity of society-wide measures of social control to curb the morbidity and mortality of the virus. ⋯ To illustrate these tensions, we discuss the public fallout between vocal members of the OSAT, an ad hoc biomedical-led organization, and the Government of Ontario in light of the disagreement on the scope of 'stay home' orders to manage the third wave of the pandemic in the Spring of 2021 and, more recently, the mass protest against mass-scale public health measures in Ottawa, Canada. We argue that while decision making under emergency conditions is a difficult task, the legitimacy of the social contract between medicine and society depends on medical experts' judicious exercise of public health ethics principles. We offer a set of recommendations for building a more collaborative response to future health crises.