Healthcare and Medicine Reference
In-Depth Information
2.1.4 Reminder Regarding Some Additional and
Fundamental Considerations
Is our correct reasoning and argumentation important to maintain and
improve the quality of care, patient safety and understanding, prevention
and control of medical error and harm? Yes, it is.
To understand this even better, let us start with a practical example:
An internist examines a patient suffering from coronary heart disease.
He or she is faced with the dilemma of pursuing the conservative (medi-
cal) treatment of coronary pathology and dysfunction or to refer the
patient to invasive cardiologists for angioplasty or to surgeons for coro-
nary bypass surgery. Where might errors occur and how should they be
In the example above, at a later date, a catheter for angioplasty mal-
functions, the patient does not need angioplasty after all, and the patient's
prognosis worsens: Why is this the case?
Two visions of the cognitive and decision making processes must be
retained, namely that of an argument and argumentation process based on
evidences and that of a step-by-step review of our diagnostic, therapeutic, or
prognostic processes both for short- and long-term care:
1. A decision such as “this patient must be transferred to surgery” can be
considered a conclusion or claim (as philosophers use to say) of the
argumentation process using evidence of all kinds. Errors may occur
not only due to the uses of poor evidence or failures to use good
evidence from one step of argumentation to another, but also due to
the linking together of various components on the way to conclusions
and recommendations. The argumentation process and model applies
practically at all steps and stages of clinical practice and health and
community care.
2. The additional, more specific cognition pathways in various clinical
practices and components of care from their original triggers to their
final understanding and ensuing decisions to be considered must be
recognized in the development of any necessary steps in risk assess-
ment (as we will see in greater detail in Chapter 3), diagnostic process,
treatment plan work-up, or prognosis with its ensuing short- and long-
term actions in care. Errors in any of these steps may cause numerous
incidents and their consequences.
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