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Clinical Judgment: Balancing Evidence-Based Medicine and Patient Self-Determination

by G. Richard Holt, MD, MSE, MPH, MABE, D Bioethics •

Dr. Holt is professor emeritus in the department of otolaryngology–head and neck surgery at the University of Texas Health Science Center in San Antonio.

Four Major Elements in Clinical Judgement

  1. Knowledge: The knowledge of anatomy, pathophysiology, metabolic pathways, evidence, pharmaco-therapeutics, surgical techniques and outcomes, and so much more acquired over the course of education, training, and practice.
  2. Critical Thinking and Interpretation: Physician knowledge, both fundamental and that which is pertinent to the individual patient through consideration of the evidence in the literature and how closely the evidence applies.
  3. Decision-Making: The culmination of acquisition of knowledge about the patient and the consideration of what recommendation(s) should be made to the patient for her/his consideration.
  4. Patient Self-Determination: Acceptance of a patient’s wishes after all information has been given and all professional recommendations have been discussed.