Medical Decision Making Musings

The importance of practical wisdom for shared decision making  He who [has practical wisdom] is skilled in aiming, in accord with calculation, at what is best for a human being in things attainable through action. ~ Aristotle The concept of practical wisdom (also called phronesis or prudence) was first described by Aristotle in Book 6 of the  Nicomacean Ethics . It was recently popularized by Barry Schwartz and Kenneth Sharpe in their 2011 book  Practical Wisdom . (1) Schwartz defines practical wisdom as the combination of:  “... the will to do the right thing with the skill to figure out what the right thing is .” (2) I first became acquainted with the concept of practical wisdom when I watched Professor Schwartz’s 2009 TED talk titled “Our Loss of Wisdom”. (3) In a related blog post, Schwartz said:  Most doctors want to practice medicine as it should be practiced. But they feel helpless faced with the challenge of balancing the needs and desires of patients wi...

  First Principles of Shared Clinical Decision Making For we do not think that we know a thing until we are acquainted with its primary conditions or first principles, and have carried out analysis as far as its simplest elements. ~ Aristotle In the October 7, 2022 post, I referred to mental models, which can be thought of as pathways for good thinking. One of the oldest mental models, first proposed by Aristotle, is called First Principles.  James Clear has written a terrific blog post describing the First Principles mental model. [1] He explains that it involves reducing a process to the basic functions needed to accomplish a specific purpose.  First Principles reasoning can be used to both gain a deeper understanding of a current process and as a mechanism to develop new, innovative ways to accomplish something.  Clear cites the Gutenberg printing press as a good example of innovation based on First Principles reasoning. Gutenberg’s innovation was combining screw...

  Decision support for shared decision making Learning from other people is what music is all about.  Neil Young In past posts I’ve discussed the problem that, although shared clinical decision making (SDM) is widely recommended, it is not frequently practiced. The medical world, or at least those interested in promoting patient-centered care through appropriate use of shared decision making, seems to have no viable solution to this problem. As far as I have been able to tell, the most common response has been to create and publish an outline of the steps involved in making a shared decision. There are also a small number of educational resources available for clinicians. Most, if not all, of these approaches seem to be primarily derived from concepts traditionally used to guide medical care and medical practice. What would happen if we took another look at what needs to be accomplished to do shared decision making in clinical settings and how it could be done? Let’s start wit...