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Postgraduate Medical Journal 2002;78:319-321
© 2002 The Fellowship of Postgraduate Medicine

EDITORIAL

Evidence based medicine

Clinical decision-making: coping with uncertainty

A F West 1, R R West 2

1 Child and Adolescent Mental Health Service, Wokingham Hospital, Wokingham, Berkshire RG41 2RE, UK
2 Epidemiology, University of Wales College of Medicine, Cardiff, UK

Correspondence to:
Correspondence to:
Dr Andrew West

Despite increasing medical knowledge uncertainty will always remain

Keywords: decision making; evidence based medicine; medical ethics; training

The first 150 words of the full text of this article appear below.


SUMMARY
Reliable research and audit information are essential to increasing medical knowledge and improving health service delivery. However there are limits to available information in terms of quality, reliability, and applicability. Furthermore, however much information is gathered, there will always be a degree of uncertainty at the point of making clinical decisions with individual patients. Unrealistic lay and professional expectations of the efficacy of information and that certainty is achievable, may be altering the traditional clinician-patient relationship. One therapeutic role of a clinician is containing the anxieties aroused in the context of uncertainty, and this role may be becoming more difficult. Reliance on protocols and fear of reprimand may lead to clinicians, in some areas of medical care, abandoning their patients at a time of need.


INTRODUCTION
Many acknowledge that there has been an information explosion in the health services over the last few decades. Vastly increased volumes of . . . [Full text of this article]




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