DOCSLIB.ORG

Decision Support in Dermatology and Medicine: History and Recent Developments Art Papier, MD

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Decision Support in Dermatology and Medicine: History and Recent Developments Art Papier, MD Decision Support in Dermatology and Medicine: History and Recent Developments Art Papier, MD This article is focused on diagnostic decision support tools and will provide a brief history of clinical decision support (CDS), examine the components of CDS and its associated terminology, and discuss recent developments in the use and application of CDS systems, particularly in the field of dermatology. For this article, we use CDS to mean an interactive system allowing input of patient-specific information and providing customized medical knowledge-based results via automated reasoning, for example, a set of rules and/or an underlying logic, and associations. Semin Cutan Med Surg 31:153-159 © 2012 Elsevier Inc. All rights reserved. KEYWORDS clinical decision support, informatics, knowledge-based systems, health informa- tion technology, diagnostic software, contact allergen database, VisualDX, Iliad s computing evolved, physicians and other researchers access to a wealth of medical knowledge. These tools range Abegan exploring ways in which computer technology from online books with electronic indices and text search could be used to manage medical information and optimize functionality to more sophisticated databases with complex health care delivery. The earliest efforts were focused on hos- mappings of terminology and information. Although a few pital information systems for recording and storing medical have broadly defined CDS as computer-based medical infor- data and for administrative support, and on decision support mation, most in the field would choose a narrower definition tools to assist in patient care decision making.1-10 This article suggesting the need to customize information to a specific is focused on decision support tools, specifically diagnostic patient or clinical scenario using Ͼ 1 variable.11 For this decision support tools, and will provide a brief history of article, we use CDS to mean an interactive system allowing clinical decision support (CDS), examine the components of input of patient-specific information and providing custom- CDS and its associated terminology, and discuss recent de- ized medical knowledge-based results via automated reason- velopments in the use and application of CDS systems, par- ing, for example, a set of rules and/or an underlying logic, and ticularly in the field of dermatology. associations. In other words, CDS is the physician interacting with the computer source in real time to assist with thinking Diagnostic Decision Support and decision making on a specific patient case. As in aviation, in medicine, human error can lead to injury and death. Sim- Much like the term “evidence-based medicine,” the term ilar to pilot resource management systems used to reduce “clinical decision support” has, to some degree, become a pilot error,12 CDS systems have the potential to increase a buzzword and an industry cachet used broadly to describe almost any electronic medical information resource. There physician’s cognitive awareness, help them recognize their are many electronic clinical reference tools currently in use knowledge limitations, and assist with problem solving and that, by the strictest definition, would not fall into the cate- decision making in a specific patient context. gory of decision support systems but do facilitate efficient Several notable computerized systems designed to aid cli- nicians in the diagnosis of disease—“diagnostic expert sys- tems”—have emerged over the past 30 years. Starting in the Dermatology and Medical Informatics, University of Rochester College of 1980s, commercially released prototypes were being imple- Medicine, Rochester, NY. mented for medical education and patient care. Although Conflict of Interest Disclosures: The author is CMIO of Logical Images, Inc, varied in methodology (ie, data organization, logic structure) developer of VisualDx. and in subject matter (ie, specialized vs more general medi- Correspondence Author: Art Papier, MD, Dermatology and Medical Informat- ics, University of Rochester College of Medicine, 601 Elmwood Ave, Box cine), diagnostic expert systems all generate differential diag- 697, Rochester, NY 14642. E-mail: [email protected] noses by computing associations between patient-specific 1085-5629/12/$-see front matter © 2012 Elsevier Inc. All rights reserved. 153 http://dx.doi.org/10.1016/j.sder.2012.06.005 154 A. Papier clinical findings (eg, patient signs and symptoms entered by Table 1 Clinical Diagnosis Decision Support Systems the clinician during the patient encounter) and diseases. Be- Iliad sides generating differential diagnoses, the systems for the Developed in early 1980s at Utah School of Medicine most part also provide general information on the diseases Uses Bayesian logic to rank diagnostic probability covered (etiology, pathology, predominating signs and Covers >1,500 internal medicine diagnoses symptoms, and therapy recommendations). This informa- No longer commercially available tion is typically available via differential listings or search by Quick Medical Reference disease, allowing for more efficient access to medical data Developed at University of Pittsburgh in 1980 than could be achieved by paging through textbooks or re- Uses non-Bayesian reasoning for internal medicine diagnosis searching journal articles. More than 5,000 clinical findings mapped to >750 One of the earliest diagnostic tools developed was Iliad diseases (University of Utah School of Medicine, Dept. of Medical No longer commercially available, last update in 2001 13 Informatics, Salt Lake City, UT). It was first created in the DXplain 1980s to assist physicians with internal medicine diagnosis. Developed in 1984 at Massachusetts General Hospital Iliad uses Bayesian reasoning to calculate probabilities of di- Relational database covering >2,400 diseases, with full agnoses in relation to patient findings entered by the physi- differentials for >5,000 clinical findings cian. DXplain (Massachusetts General Hospital Lab. of Com- Currently in use by hospitals and medical schools puter Science, Boston, MA), also released in the 1980s, PKC Advisor covers general medicine diagnosis.14 Using a modified form Developed by Dr. Lawrence Weed at the University of of Bayesian logic, the system ranks diagnostic possibilities Vermont Uses combinatorial logic to provide differential diagnosis from most likely to least likely on the basis of finding fre- for a variety of problem-based topics quency and importance in relation to diagnoses. DXplain is Commercially available to institutions presently used primarily as a clinical education tool but can Isabel also be used for clinical reference. Quick Medical Reference Launched in 2002 with support from UK National Health (University of Pittsburgh, PA; First DataBank, Inc., San Service and UK Department of Health Bruno, CA) is another diagnostic program for internal med- Search engine allowing natural language processing of icine that uses a non-Bayesian algorithm to assess associa- patient-specific queries tions between patient findings and individual diseases and Licenses/links to 100,000 documents produce a list of potential diagnoses.15 Isabel (Isabel Health- Commercially available to individuals and institutions care, Ltd., Haslemere, UK) is a diagnosis decision support VisualDx system released in 2002. It was initially designed for pediatric Released through a partnership with the University of Rochester in 2001 medicine but now covers all age-groups. As with the other First visual diagnostic decision support system systems, it provides a list of possible diagnoses based on Relational database covering >1,200 disease topics and physician entry of patient data. It is unique in that it uses containing >24,000 images, approximately 36,000 natural language processing, as will IBM’s (Armonk, NY) finding–diagnosis relationships, and >5,000 soon-to-be-released Watson project in health care. Like other medication–disease relationships systems, Isabel links to external knowledge sources related to Commercially available to individuals and institutions a disease (eg, journal article abstract). However it does not publish its own clinical content.16 There are others, too, such as PKC Advisor (PKC Corp., Burlington, VT), which uses combinatorial logic to provide differential diagnosis for a might use differing lists of symptoms, signs, diagnoses, and variety of problem-based topics, such as “chest pain” or “con- other terms. However, if digital systems are going to commu- stipation.” However, it does not publish its own clinical con- nicate accurately, there must be shared standardized terms to tent.16 First introduced in 2001, VisualDx is an image-rich ensure reliability and prevent error. In the field of dermatol- diagnostic CDS system that allows input of visual clues, ogy, one of the first large-scale efforts to standardize termi- symptoms, and patient history to assist physicians in diagno- nology was the British Association of Dermatologists (Lon- sis and management of diseases. A summary of CDS tool don, UK) lexicon project led by Dr Robert Chalmers. The characteristics is provided in Table 1. National Institute of Arthritis and Musculoskeletal and Skin Diseases (Bethesda, MD) also recognized a need to develop a Building Blocks of CDS dermatology lexicon and funded the Dermatology Lexicon Project in 2001.17 The American Academy of Dermatology CDS systems require certain foundational building blocks if (Schaumburg, IL) assumed responsibility of the Dermatology they are to work safely, be in the workflow,
Load more

Recommended publications
  • The Incidence of Diagnostic Error in Medicine
    BMJ Quality & Safety Online First, published on 7 August 2013 as 10.1136/bmjqs-2012-001615NARRATIVE REVIEW BMJ Qual Saf: first published as 10.1136/bmjqs-2012-001615 on 15 June 2013. Downloaded from The incidence of diagnostic error in medicine Mark L Graber ▸ Additional material is ABSTRACT wrong, missed, or egregiously delayed? published online only. To view A wide variety of research studies suggest that How often do diagnostic errors cause please visit the journal online (http://dx.doi.org/10.1136/bmjqs- breakdowns in the diagnostic process result in a harm? In this report, we briefly summar- 2012-001615). staggering toll of harm and patient deaths. ise the methods that have been used to These include autopsy studies, case reviews, estimate the rate of diagnostic error, Correspondence to Dr Mark L Graber, RTI surveys of patient and physicians, voluntary and comment on their relative merits and International, SUNY Stony Brook reporting systems, using standardised patients, limitations. A more comprehensive pres- School of Medicine, 1 Breezy second reviews, diagnostic testing audits and entation of studies using each of these Hollow, St James, NY 11780, closed claims reviews. Although these different methodologies has been presented USA; [email protected] approaches provide important information and elsewhere.6 Received 5 November 2012 unique insights regarding diagnostic errors, each Revised 28 April 2013 has limitations and none is well suited to Accepted 30 April 2013 THE INCIDENCE OF DIAGNOSTIC establishing the incidence of diagnostic error in ERROR actual practice, or the aggregate rate of error Arthur Elstein, a cognitive psychologist and harm. We argue that being able to measure interested in ‘how doctors think’, studied the incidence of diagnostic error is essential to clinical decision making for his entire enable research studies on diagnostic error, and career and concluded the diagnosis is to initiate quality improvement projects aimed at wrong 10–15% of the time.7 A diverse reducing the risk of error and harm.
    [Show full text]
  • WHAT DOCTORS FEEL How Emotions Affect the Practice of Medicine Danielle Ofri, MD
    Beacon Press Discussion Guide WHAT DOCTORS FEEL How Emotions Affect the Practice of Medicine Danielle Ofri, MD Contents: About the Book Praise About the Author Questions for Discussion About the Book In this book of real-life stories intermixed with the latest research, Dr. Danielle Ofri examines the often overlooked aspect of medicine—how doctors feel. By shedding light on how doctors cope with the stresses and responsibilities of patients, colleagues, lawyers, and their personal lives, she explains why it is important that patients know how emotions influence the way physicians treat their patients both medically and interpersonally. Exploring the full range of human emotion—from the fear of making a fatal mistake to the pride and elation of triumphing over death, What Doctors Feel allows patients at the other end of the stethoscope to have a good listen to the beat of the emotional life behind the white coat. Praise “The world of patient and doctor exists in a special sacred space. Danielle Ofri brings us into that place where science and the soul meet. Her vivid and moving prose enriches the mind and turns the heart.” —Jerome Groopman, author of How Doctors Think “Danielle Ofri is a finely gifted writer, a born storyteller as well as a born physician.” —Oliver A discussion guide for What Doctors Feel Page 1 Sacks, author of Awakenings “Danielle Ofri … is dogged, perceptive, unafraid, and willing to probe her own motives, as well as those of others. This is what it takes for a good physician to arrive at the truth, and these same qualities make her an essayist of the first order.” —Abraham Verghese, author of Cutting for Stone “Her writing tumbles forth with color and emotion.
    [Show full text]
  • How Doctors Think by Jerome Groopman, M.D
    Dr. Pam Popper’s Book Review How Doctors Think By Jerome Groopman, M.D. A significant part of my life’s work is showing people how they can stay out of doctors’ offices and hospitals. However, there are times when it is appropriate to see a medical doctor, or for hospitalization. This book, although parts of it are quite scary, is a must-read for anyone who is or will be dealing with traditional medical practice. The author, Jerome Groopman, is a medical doctor who has had first-hand experience, both through his medical practice and as a patient, with the shortcomings of traditional practice. He states that the book was written for lay people although he hopes doctors will read it. According to Dr. Groopman, the book is directed at patients so they can be better advocates for themselves when dealing with doctors, who often need patients and their families and friends to help them think, and to provide clues as to what is wrong. Patients also have to be very proactive in order to overcome the prejudices and thinking patterns that are common to many doctors. Judith Hall, professor of social psychology at Northeastern University, has conducted research on rapport between doctors and patients. According to her research, the sickest patients are least liked by doctors, and sick people are subconsciously aware of this. Doctors tend to like healthier people, one of the reasons being that doctors often have feelings of failure when dealing with sick patients who they are unable to help, and become frustrated as a result.
    [Show full text]
  • |||GET||| How Doctors Think 1St Edition
    HOW DOCTORS THINK 1ST EDITION DOWNLOAD FREE Jerome Groopman | 9780618610037 | | | | | How Doctors Think and Learn For example, we use cookies to conduct research and diagnostics to improve our content, products and services, and to measure and analyse the performance of our services. To the query, Lock gives the cryptic response, "All my mistakes have the same things in common. Help Learn to edit Community portal Recent changes Upload file. These cookies are necessary to provide our site and services and therefore cannot be disabled. Groopman lifts the veil on the most taboo topic Groopman also serves as an advocate for primary care physicians in his book. Deductive reasoning doesn't work for every case. How Doctors Think. About this book This book describes the theoretical basis for the acquisition; development and refining of professional medical skills from entry level into professional training to those developing specialist expertise. How Doctors Think reveals a profound new view of twenty-first-century medical practice, giving doctors and patients the vital information they need to make better judgments together. He gives the following tools that patients can use to help reduce or rectify cognitive errors:. Often, decisions made this way are correct, but at crucial moments they can also be wrong—with catastrophic consequences. How Doctors Think 1st edition explores why doctors err and shows when and how they can—with our help—avoid snap judgments, embrace uncertainty, communicate How Doctors Think 1st edition, and deploy other skills that can profoundly impact our health. This book describes the theoretical basis for the acquisition; development and refining of professional medical skills from entry level into professional training to those developing specialist expertise.
    [Show full text]
  • Analytics and Algorithms, Big Data, Cognitive Computing, and Deep Learning in Healthcare and Medicine
    ! ANALYTICS AND ALGORITHMS, BIG DATA, COGNITIVE COMPUTING, AND DEEP LEARNING IN HEALTHCARE AND MEDICINE ! ANTHONY CHANG, MD, MBA, MPH, MS CHIEF INTELLIGENCE AND INNOVATION OFFICER MEDICAL DIRECTOR, THE SHARON DISNEY LUND MEDICAL IN- TELLIGENCE AND INNOVATION INSTITUTE (MI3) CHILDREN’S HOSPITAL OF ORANGE COUNTY Anthony C. Chang, MD, MBA, MPH, MS Dr. Chang attended Johns Hopkins University for his B.A. in molecular biology prior to entering Georgetown University School of Medicine for his M.D. He then completed his pediatric residency at Children’s Hospital National Medical Center and his pediatric cardiology fellowship at the Children’s Hospital of Philadelphia. He then accepted a position as attending cardiologist in the cardiovascular intensive care unit of Boston Children’s Hospital and as assistant professor at Harvard Medical School. He has been the medical director of several pediatric cardiac intensive care programs (including Children’s Hospital of Los Angeles, Miami Children’s Hospital, and Texas Children’s Hospital). He served as the medical director of the Heart Institute at Children’s Hospital of Orange County. He is currently the Chief Intelligence and Innovation Officer and Medical Director of the Heart Failure Program at Children’s Hospital of Orange County. He has also been named a Physician of Excellence by the Orange County Medical Association and Top Cardiologist, Top Doctor for many years. He has completed a Masters in Business Administration (MBA) in Health Care Administration at the University of Miami School of Business and graduated with the McCaw Award of Academic Excellence. He also completed a Masters in Public Health (MPH) in Health Care Policy at the Jonathan Fielding School of Public Health of the University of California, Los Angeles and graduated with the Dean’s Award for Academic Excellence.
    [Show full text]
  • A Preventable Mode of Diagnostic
    Journal of Evaluation in Clinical Practice ISSN 1356-1294 Misleading one detail: a preventable mode of diagnostic error?jep_1098 804..806 Shahar Arzy MD PhD,1 Mayer Brezis MD MPH,2 Salim Khoury MD,3 Steven R. Simon MD MPH4 and Tamir Ben-Hur MD PhD5 1Neurologist, Department of Neurology, Hadassah Hebrew University Hospital, Jerusalem, Israel and Research fellow, Laboratory of Cognitive Neuroscience, Brain Mind Institute, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland 2Professor, Centre for Clinical Quality and Safety, Hadassah Hebrew University Hospital, Jerusalem, Israel 3Neurologist, Department of Neurology, Hadassah Hebrew University Hospital, Jerusalem, Israel 4Associate Professor, Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, MA, USA 5Head and Professor of Neurology, Department of Neurology, Hadassah Hebrew University Hospital, Jerusalem, Israel Keywords Abstract clinical decision making, clinical errors, cognitive disposition Rationale, aims and objectives Despite advances in our understanding of cognitive biases in clinical practice, little is known about correction or prevention of diagnostic errors. The Correspondence presence of a single misleading detail may lead clinicians down a cognitive and actual path Dr Shahar Arzy toward an incorrect diagnosis. Department of Neurology Methods In a large teaching hospital, we surveyed 51 attending doctors in internal medi- Hadassah Hebrew University Hospital cine, presenting each with 10 clinical vignettes and soliciting their diagnosis of the con- 91120 Jerusalem dition leading to the presentation. Each of the 10 clinical cases included a single misleading Israel detail. E-mail: [email protected] Results This survey elicited a wrong diagnosis in 90% of cases, which was reduced to 30% when omitting the misleading detail from the vignette.
    [Show full text]
  • Consumerism in Health Care: Challenges and Opportunities Richard Zeckhauser, Phd, and Benjamin Sommers, MD, Phd
    Virtual Mentor American Medical Association Journal of Ethics November 2013, Volume 15, Number 11: 988-992. OP-ED Consumerism in Health Care: Challenges and Opportunities Richard Zeckhauser, PhD, and Benjamin Sommers, MD, PhD The era of consumerism in health care has arrived. Direct-to-consumer advertising of pharmaceuticals, health newsletters from leading hospitals and medical schools, and, most importantly, the near-ubiquity of the Internet have made it easy for consumers to obtain information about their medical conditions and possible treatments. This presents health care providers and patients with both challenges and opportunities. Challenges of Consumerism in Patient Care Some studies suggest that patients’ consumerism can negatively affect the quality of patient-doctor communications [1, 2]. Physicians are constrained by schedules that limit the typical office visit to 17 minutes [3]. In this context, spending a considerable portion of appointment time trying to correct misperceptions held by consumerist patients who may hold strong opinions with little medical or scientific background is inefficient and impractical. In addition, consumerism among patients may engender negative feelings among doctors. Physicians may feel that consumerism erodes the respect accorded to their profession [4], and many physicians have mixed feelings about discussing web-based medical information during the clinical encounter [5]. Difficulties can arise when the patient’s preconceptions clash with the doctor’s assessment. Perhaps less information gets effectively exchanged. Even when more information is in fact exchanged, the patient may discount what he or she hears from the doctor. Consider a patient who arrives at the doctor’s office, having already settled in his or her own mind on a diagnosis and preferred treatment.
    [Show full text]
  • Videos and Books Related to Health Professions Extracted From
    Videos and books related to health professions Extracted from www.Explorehealthcareers.com How do you know if a health care career is right for you? You find out as much about it as you can. These documentaries can take you into the health care world and introduce you to health care professionals doing the work you may be doing one day. (And don’t forget there are a lot of good reads about health care too on our reading list.) The American Nurse This film explores some of the biggest issues facing America – aging, war, poverty, prisons – through the work and lives of five nurses: Jason Short with home-bound patients in Appalachia; Tonia Faust with prison inmates providing hospice care; Naomi Cross bringing babies into the world in Labor & Delivery; Sister Stephen running a nursing home where the entire nursing staff comes together to sing for dying residents; and Army veteran Brian McMillion rehabilitating wounded soldiers returning from war. It is an examination of real people that will change how we think about nurses and how we wrestle with the challenges of healing America. Cancer: The Emperor of All Maladies A three-part, six-hour series, The Emperor of All Maladies debuted on PBS in March 2015. The documentary is based on the 2010 Pulitzer Prize-winning book, The Emperor of All Maladies: A Biography of Cancer, by Siddhartha Mukherjee. This “biography” of cancer covers its first documented appearances thousands of years ago through the epic battles in the 20th century to cure, control and conquer it, to a radical new understanding of its essence.
    [Show full text]
  • How Do Doctors Think?'
    News View Edit Revisions Google Search: 'How Do Doctors Think?' New executive education program teaches tech leaders art, science of medicine By ELIZABETH COONEY March 9, 2016 Googlers reveal what they learned at HMS executive education course. Video: Rick Groleau and Elizabeth Cooney On a daily basis, more than a billion users around the world turn to Internet search giant Google for answers to nearly any question that can be imagined. But where does Google go to learn? This year for the first time, groups of Googlers, as they call themselves, came to Harvard Medical School for instruction. Get more HMS news here “When we build our product, we try to empathize with our users,” said Prem Ramaswami, a Google senior product manager who focuses on health search for the company. “I think one of the biggest values our team has gained from these classes has been empathy for what the doctor is going through. I cannot stress how instructive and humbling this experience has been for us from the Google perspective,” he said. "I think one of the biggest values our team has gained from these classes has been empathy for what the doctor is going through." — Prem Ramaswami. In weeklong sessions in Boston, alternating with a shorter stint at Google headquarters in California, the new HMS executive education program, which began last fall, is bringing together academic physicians, surgeons, researchers and health care policy experts to teach both the art and science of the doctor-patient relationship. During classes, HMS instructors have fielded challenging questions from inquisitive Googlers who work in search, clinical genomics, informatics and other frontiers of technology.
    [Show full text]
  • Flesh-And-Blood Decision-Making
    chapter 1 Flesh-and-Blood Decision-Making n a sweltering morning in June 1976, I put on a starched white coat, placed a stethoscope in my black Obag, and checked for the third time in the mirror that my tie was correctly knotted. Despite the heat, I walked briskly along Cambridge Street to the entrance of the Massachusetts General Hospital. This was the long-awaited moment, my first day of internship — the end of play-acting as a doctor, the start of being a real one. My medical school classmates and I had spent the first two years in lecture halls and in laboratories, learning anatomy, physiology, pharmacology, and pathology from text- books and manuals, using microscopes and petri dishes to per- form experiments. The following two years, we learned at the bedside. We were taught how to organize a patient’s history: his chief complaint, associated symptoms, past medical history, rele- vant social data, past and current therapies. Then we were in- structed in how to examine people: listening for normal and ab- normal heart sounds; palpating the liver and spleen; checking pulses in the neck, arms, and legs; observing the contour of the nerve and splay of the vessels in the retina. At each step we were 27 how doctors think closely supervised, our hands firmly held by our mentors, the at- tending physicians. Throughout those four years of medical school, I was an in- tense, driven student, gripped by the belief that I had to learn every fact and detail so that I might one day take responsibility for a patient’s life.
    [Show full text]
  • Thinking About Diagnostic Thinking: a 30-Year Perspective
    Adv in Health Sci Educ (2009) 14:7–18 DOI 10.1007/s10459-009-9184-0 ORIGINAL PAPER Thinking about diagnostic thinking: a 30-year perspective Arthur S. Elstein Received: 14 July 2009 / Accepted: 14 July 2009 / Published online: 11 August 2009 Ó Springer Science+Business Media B.V. 2009 Abstract This paper has five objectives: (a) to review the scientific background of, and major findings reported in, Medical Problem Solving, now widely recognized as a classic in the field; (b) to compare these results with some of the findings in a recent best-selling collection of case studies; (c) to summarize criticisms of the hypothesis-testing model and to show how these led to greater emphasis on the role of clinical experience and prior knowledge in diagnostic reasoning; (d) to review some common errors in diagnostic reasoning; (e) to examine strategies to reduce the rate of diagnostic errors, including evidence-based medicine and systematic reviews to augment personal knowledge, guide- lines and clinical algorithms, computer-based diagnostic decision support systems and second opinions to facilitate deliberation, and better feedback. Keywords Clinical judgment Á Problem solving Á Clinical reasoning Á Cognitive processes Á Hypothetico-deductive method Á Expertise Á Intuitive versus analytic reasoning Accounts of clinical reasoning fall into one of two categories. The first comprises narra- tives or reports of interesting or puzzling cases, clinical mysteries that are somehow explicated by the clever reasoning of an expert. The narrative includes both the solution of the mystery and the problem solver’s account of how the puzzle was unraveled. These case reports resemble detective stories, with the expert diagnostician cast in the role of detec- tive.1 A recent example of this genre is ‘‘How Doctors Think’’, a collection of stories of clinical reasoning that has become a best-seller (Groopman 2007).
    [Show full text]
  • Mindfulness in Medicine
    Mindfulness in Medicine David S. Ludwig; Jon Kabat-Zinn JAMA. 2008;300(11):1350-1352 (doi:10.1001/jama.300.11.1350) Online article and related content current as of September 19, 2008. http://jama.ama-assn.org/cgi/content/full/300/11/1350 Correction Contact me if this article is corrected. Citations Contact me when this article is cited. Topic collections Complementary and Alternative Medicine; Patient-Physician Relationship/ Care; Patient-Physician Communication; Psychiatry; Cognitive Therapy; Depression Contact me when new articles are published in these topic areas. Subscribe Email Alerts http://jama.com/subscribe http://jamaarchives.com/alerts Permissions Reprints/E-prints [email protected] [email protected] http://pubs.ama-assn.org/misc/permissions.dtl Downloaded from www.jama.com at University of Arizona on September 19, 2008 COMMENTARIES security, one could reasonably defend it even if it violates Financial Disclosures: None reported. Additional Contributions: Robert Michels, MD (Department of Psychiatry, Weill the profession’s code of ethics and is personally damaging Medical College, New York, New York), provided thoughtful comments on this to that individual. In a controversial psychobiography of topic. Dr Michels received no compensation for his contribution. President George W. Bush, Frank, a psychiatrist, charac- terized the president as a “paranoid megalomaniac” and “un- REFERENCES 14 treated alcoholic.” Although these are clearly clinical and 1. Kocieniewski D. Felled by scandal, Spitzer says focus is on his family. The New diagnostic labels that appear to violate the Goldwater Rule, York Times. March 13, 2008:A1. 2. Carmichael M. His cheating brain. Newsweek. March 12, 2008;Psychology sec- Frank’s view is that his book is a scholarly psychobiogra- tion:1.
    [Show full text]