Healthcare and Medicine Reference
In-Depth Information
best specific and general evidence available applies not only to clinical
and community medicine research, but also to various ways of reason-
ing and its communication, be it dialogs between colleagues, progress
notes in patients' charts, discussing cases on morning reports, morbid-
ity and mortality review meetings, consults or discharge notes. Let us
keep it in mind.
Table 2.3 Daily Communication of an Argumentative Nature between
Clinicians in Natural Language in a Hospital Setting
Component of the
Attending: I was
told that you had
a busy morning
here. Any new
admissions at our
Resident : “ Yes, we admitted an elderly
lady with chest pain.
Original idea,
problem in context:
Setting of the
problem to be
Attending: What
led you to admit
Resident : “ Well, the senior resident told
me to do so! But more seriously, this
patient was transferred to us from the
emergency room with a working
diagnosis of myocardial infarction .”
Claim: Proposition
resulting from our
Attending: What
brought you to
this diagnosis and
treatment and
care orders?
Resident: In the past, this patient had
some unchecked chest pains , but this
time, her pain radiated to both arms, she
had low systolic blood pressure , and we
heard a third heart sound on
auscultation. On the ECG, we saw a new
ST segment elevation, a new Q wave and a
new conduction defect .”
Grounds: Basis from
which we reason
and argue. Facts
supporting the
Resident: I would
like to know if
there are any
steps that I must
follow in future
similar cases .”
Attending: In such and similar cases of
myocardial infarction, especially if
confirmed by ECG, MRI, serum cardiac
enzymes, we give aspirin and
clopidogrel, start thrombolytic treatment
and consider coronary angiography and
stenting .”
Warrant: General
rule that permits us
to infer a claim
from grounds.
( Continued )
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