en pl
en pl

Decyzje

Zobacz wydanie
Rok 12/2019 
Numer 32

Racjonalne modele rozumowania klinicznego

Wojciech Rutkiewicz
Uniwersytet Warszawski

12/2019 (32) Decyzje

DOI 10.7206/DEC.1733-0092.132

Abstrakt

Debata dotycząca medycyny opartej na dowodach (EBM) w obecnym stanie coraz częściej skupia się na filozoficznych założeniach paradygmatu ogłoszonego w 1992 roku przez Grupę Roboczą EBM. Jednym z obszarów zainteresowania badaczy jest problem rozumowania klinicznego, prowadzącego do wydania diagnozy oraz podjęcia decyzji klinicznej. W polskiej literaturze temat ten wciąż nie doczekał się wyczerpującego zaprezentowania. W niniejszym artykule dokonuję przeglądu modeli rozumowania klinicznego. Zaczynam od debaty o pojęciu racjonalności, w której wyróżniam dwa stanowiska: melioryzm i panglozjanizm. Następnie przechodzę do omówienia trzech typów ujęcia rozumowania klinicznego w perspektywie meliorystycznej. Omówienie modeli rozumowania lekarskiego z perspektywy debaty o racjonalności daje możliwość przyjrzenia się regułom rozumowania przyświecającym decyzjom klinicznym, co może mieć ciekawe konsekwencje badawcze i edukacyjne.

Powiązania

  1. Andersen, H. (2012). Mechanisms: what are they evidence for in evidence-based medicine? Journal of Evaluation in Clinical Practice, 18, 992–999. [Google Scholar]
  2. Ashby, D. (2006). Bayesian Statistics in medicine: A 25 year review. Statistics in Medicine, 25, 3589–3631. [Google Scholar]
  3. Ashby, D., Smith, M.F.A. (2000). Evidence-based medicine as Bayesian decision-making. Statistic in Medicine, 19, 3291–3305. [Google Scholar]
  4. Bailey, L. (2010). Strategies for Decreasing Patient Anxiety in the Perioperative Setting. AORN Journal, 92(4), 445–457. [Google Scholar]
  5. Basinga, P., Moreira, J., Bisoffi , Z., Bisig, B., van den Ende, J. (2007). Why Are Clinicians Reluctant To Treat Smear-Negative Tuberculosis? An Inquiry about Treatment Thresholds in Rwanda. Medical Decision Making, 27, 53–60. [Google Scholar]
  6. Bekker, L.H. (2009). Using decision-making theory to inform clinical practice. W: Edwards, A., Glyn, E. (red.), Shared Decision-Making in Health Care (45–52). Oxford: Oxford University Press. [Google Scholar]
  7. Cahan, A., Dilon, G., Manor, O., Paltiel, O. (2003). Probabilistic reasoning and clinical decision-making: do doctors overestimate diagnostic probabilities? QJM: Monthly Journal of the Association of Physicians, 96, 763–769. [Google Scholar]
  8. Campitelli G., Gobet, F. (2010). Herbert Simon’s Decision-Making Approach: Investigation of Cognitive Processes in Experts. Review of General Psychology, 14(4), 354–364. [Google Scholar]
  9. Cartwright, N. (2007). Are RCTs the Gold Standard? BioSocieties, 2, 11–20. [Google Scholar]
  10. Cartwright, N. (2011). A philosopher’s view of the long road from RCTs to effectiveness. The Lancet, 377, 1400–1401. [Google Scholar]
  11. Cartwright, N., Munro, E. (2010). The limitations of randomized controlled trials in predicting effectiveness. Journal of Evaluation in Clinical Practice, 16, 260–266. [Google Scholar]
  12. Charlton, G.B., Miles, A. (1998). The rise and fall of EBM. QJM: Monthly Journal of the Association of Physicians, 91, 371–374. [Google Scholar]
  13. Cheeseman, P. (1985). In Defense of Probability. Proceedings of the 9th international joint conference on Artifi cial intelligence, 2, 1002-1009. [Google Scholar]
  14. Concato J., Shah, N., Horwitz, I.R. (2000). Randomized, controlled trials, observational studies and the hierarchy of research designs. The New England Journal of Medicine, 342(25), 1887–1892. [Google Scholar]
  15. Corallo, N.A., Croxford, R., Goodman, C.D., Bryan, L.E., Srivastava, D., Stukel, A.T. (2014). A systematic review of medical practice variation in OECD countries. Health Policy, 114, 5–14. [Google Scholar]
  16. Corner, A., Hahn, U. (2013). Normative theories of argumentation: are some norms better than others? Synthese, 190, 3579–3610. [Google Scholar]
  17. Croskerry, P. (2002). Achieving Quality in Clinical Decision Making: Cognitive Strategies and Detection of Bias. Academic Emergency Medicine, 9(11), 1184–1204. [Google Scholar]
  18. Davidoff, F. (1999). Standing Statistics Right Side Up. Annals of Internal Medicine, 130(12), 1019–1021. [Google Scholar]
  19. Deeks, J.J., Altman, G. D. (2004). Diagnostic tests 4: likelihood ratios. British Medical Journal, 329, 168–169. [Google Scholar]
  20. Djulbegovic, B., Elqayam, S. (2017). Many faces of rationality: Implications of the great rationality debate for clinical decision-making. Journal of Evaluation in Clinical Practice, 23, 915–922. [Google Scholar]
  21. Djulbegovic, B., Elqayam, S., Dale, W. (2018). Rational decision making in medicine: Implications for overuse and underuse. Journal of Evaluation in Clinical Practice, 24, 655–665. [Google Scholar]
  22. Djulbegovic, B., Elqayam, S., Reljic, T., Hozo, I., Miladinovic, B., Tsalatsanis, A., Kumar, A., Beckstead, J., Taylor, S., Canon-Bowers, J. (2014). How do physicians decide to treat: an empirical evaluation of the threshold model. BMC Medical Informatics and Decision Making, 14(47). [Google Scholar]
  23. Djulbegovic, B., Ende van den, J., Hamm, R., Mayrhofer, T., Hozo, I., Pauker, S. (2015). When is rational to order a diagnostic test, or prescribe treatment: the threshold model as an explanation of practice variation. European Journal of Clinical Investigation, 45(15), 485–493. [Google Scholar]
  24. Djulbegovic, B., Hozo, I., Mayrhofer, T., Ende van den, J., Guyatt, G. (2019). The threshold model revisited. Journal of Evaluation in Clinical Practice, 25, 186–195. [Google Scholar]
  25. Domurat, A., Zieliński, T. (2013). Niepewność i niejasność jako uwarunkowania decyzji ekonomicznych. Decyzje, 20, 21–47. [Google Scholar]
  26. Duggan, F.P. (1992). Time to abolish “gold standard”. British Medical Journal, 304, 1568–1569. [Google Scholar]
  27. Dutt, A.K., Stead, W.W. (1994). Smear-Negative Pulmonary Tuberculosis. Seminars in Respiratory Infections, 9(2), 113–119. [Google Scholar]
  28. Edwards, F.W.A. (1974). The History of Likelihood. International Statistical Review, 42(1), 9–15. [Google Scholar]
  29. Eisenberg, M.J., Hershey, C.J. (1983). Derived Thresholds: Determining the Diagnostic Probabilities at Which Clinicians Initiate Testing and Treatment. Medical Decision Making, 3 (2), 155–168. [Google Scholar]
  30. Elqayam, S., Evans, S.J. (2011). Subtracting “ought” from “is”: Descriptivism versus normativism in the study of human thinking. Behavioral and Brain Sciences, 34, 233–290. [Google Scholar]
  31. Elqayam, S., Evans, S.J. (2013). Rationality in the new paradigm: Strict versus soft Bayesian approaches. Thinking & Reasoning, 19, 453–470. [Google Scholar]
  32. Elstein, S.A. (1999). Heuristics and Biases: Selected Errors in Clinical Reasoning. Academic Medicine, 74(7), 791–794. [Google Scholar]
  33. Evans, S.J. (2003). In two minds: dual-process accounts of reasoning. TRENDS in Cognitive Sciences, 7(10), 454–459. [Google Scholar]
  34. Evans, S.J., Stanovich, E.K. (2013). Dual-Process Theories of Higher Cognition: Advancing the Debate. Perspectives on Psychological Science, 8, 223–241. [Google Scholar]
  35. Fava, A.G. (2017). Evidence-based medicine was bound to fail: a report to Alvan Feinstein. Journal of Clinical Epidemiology, 84, 3–7. [Google Scholar]
  36. Gajewski, P., Jaeschke, R., Brożek, J. (red.). (2008). Podstawy EBM, czyli medycyny opartej na danych naukowych: dla lekarzy i studentów medycyny. Kraków: Medycyna Praktyczna. [Google Scholar]
  37. Gigerenzer, G. (1996). On Narrow Norms and Vague Heuristics: A Reply to Kahneman and Tversky. Psychological Review, 103(3), 592–596. [Google Scholar]
  38. Goldenberg, J.M. (2006). On evidence and evidence-based medicine: Lessons from the philosophy of science. Social Science & Medicine, 62, 2621–2632. [Google Scholar]
  39. Golik, J. (2016). Krótka historia paradoksu petersburskiego i jego wczesnych rozwiązań. W: Garnek, J. (red.), Oblicze 2016 (65–76), Poznań: Koło Naukowe Matematyków UAM. [Google Scholar]
  40. Goodman, N.S. (1999). Toward Evidence-Based Medical Statistics. 1: The P Value Fallacy. Annals of Internal Medicine, 130(12), 995–1004. [Google Scholar]
  41. Goodman, N.S. (1999). Toward Evidence-Based Medical Statistics. 2: The Bayes Factor. Annals of Internal Medicine, 130(12), 1005–1013. [Google Scholar]
  42. Grimes, A.D., Schulz, F.K. (2005). Refi ning clinical diagnosis with likelihood ratios. The Lancet, 365, 1500–1505. [Google Scholar]
  43. Grossman, J., Mackenzie, J.F. (2005). The randomized controlled trial. Gold standard, or merely standard? Perspectives in Biology and Medicine 48(4), 516–534. [Google Scholar]
  44. Grzybowski, A. (2012). Matematyczne modele konfl iktu: wykłady z teorii gier i decyzji, Częstochowa: Wydawnictwo Politechniki Częstochowskiej. [Google Scholar]
  45. Hájek, A. (2007). The reference class problem is your problem too. Synthese, 156, 563–585. [Google Scholar]
  46. Haynes, B.R. (2002). What kind of evidence is it that Evidence-Based Medicine advocates want health care providers and consumers to pay attention to? BMC Health Services Research, 2(3). [Google Scholar]
  47. Hitt, J. (2001). The Year in Ideas A to Z: Evidence-Based Medicine. Pobrane z: https://www.nytimes. com/2001/12/09/magazine/the-year-in-ideas-a-to-z-evidence-based-medicine.html [data dostępu: 18.09.2019]. [Google Scholar]
  48. Horwitz, I.R., Singer, H.B. (2017). Why evidence-based medicine failed in patient care and medicine-based evidence will succeed. Journal of Clinical Epidemiology, 84, 14–17. [Google Scholar]
  49. Kahneman, D., Tversky, A. (1979). Prospect Theory: An Analysis of Decision under Risk. Econometrica, 47(2), 263–292. [Google Scholar]
  50. Kahneman, D., Tversky, A. (1996). On the Reality of Cognitive Illusions. Psychological Review, 103(3), 582–591. [Google Scholar]
  51. Kahneman, D. (2003). Maps of Bounded Rationality: Psychology for Behavioral Economics. American Economic Review, 93(5), 1449–1475. [Google Scholar]
  52. Kahneman, D. (2012). Pułapki myślenia. O myśleniu szybkim i wolnym. Poznań: Media Rodzina. [Google Scholar]
  53. Kestin, I. (2015). Statistics in medicine. Anaesthesia and Intensive Care Medicine, 16(4), 200–207. [Google Scholar]
  54. Lehman, L.E. (1993). The Fisher, Neyman-Pearson Theories of Testing Hypotheses: One Theory or Two? Journal of the American Statistical Association, 88(424), 1242–1249. [Google Scholar]
  55. Meyer, M. (2007). Herbert Simon i jego idea ograniczonej racjonalności. Decyzje, 7, 111–115. [Google Scholar]
  56. Miles, A., Loughlin, M., Polychronis, A. (2008). Evidence-based healthcare, clinical knowledge and the rise of personalized medicine. Journal of Evaluation in Clinical Practice, 14, 621–649. [Google Scholar]
  57. Montgomery, A.A., Fahey, T. (2001). How do patients’ treatment preferences compare with those of clinicians? Quality in Health Care, 10, i39–i43. [Google Scholar]
  58. Pauker, G.S., Kassirer, P.J. (1975). Therapeutic Decision Making: A Cost-Benefi t Analysis. The New England Journal of Medicine, 293, 229–234. [Google Scholar]
  59. Pauker, G.S., Kassirer, P.J. (1980). The Threshold Approach To Clinical Decision Making. The New England Journal of Medicine, 302, 1109–1117. [Google Scholar]
  60. Paul, R.J. (1938). President’s Address Clinical Epidemiology. The Journal of Clinical Investigations, 17(5), 539–541. [Google Scholar]
  61. Perezgonzalez, D.J. (2015). Fisher, Neyman-Pearson or NHST? A tutorial for teaching data testing. Frontiers in psychology, 6, 223. [Google Scholar]
  62. Polski Instytut EBM, (2003). Statut Fundacji „Polski Instytut Evidence Based Medicine”. Pobrane z: http://ebm.org.pl/show.php?aid=160889 [data dostępu: 18.09.2019]. [Google Scholar]
  63. Rawlins, D.M. (2018). Evidence-based medicine. Medicine, 46(7), 388–392. [Google Scholar]
  64. Rosenberg, F.W., Lachin, M.J. (2016). Randomization in Clinical Trials. New Jersey: John Wiley & Sons. [Google Scholar]
  65. Rutkiewicz, W. (2018). Normatywność i deskryptywność wnioskowania diagnostycznego w nurcie evidence-based medicine. Filozofi a Nauki, 3(103), 26, 79–98. [Google Scholar]
  66. Rzepiński, T. (2009). Interpretacje pojęcia prawdopodobieństwa w sporze o randomizację. Nowiny Lekarskie, 78(5–6), 360–365. [Google Scholar]

Kompletne metadane

Cytowanie zasobu

APA style

Rutkiewicz, Wojciech (2019). Racjonalne modele rozumowania klinicznego. (2019). Racjonalne modele rozumowania klinicznego. Decyzje, (32), 77-102. https://doi.org/10.7206/DEC.1733-0092.132 (Original work published 12/2019n.e.)

MLA style

Rutkiewicz, Wojciech. „Racjonalne Modele Rozumowania Klinicznego”. 12/2019n.e. Decyzje, nr 32, 2019, ss. 77-102.

Chicago style

Rutkiewicz, Wojciech. „Racjonalne Modele Rozumowania Klinicznego”. Decyzje, Decyzje, nr 32 (2019): 77-102. doi:10.7206/DEC.1733-0092.132.