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Chapter 10 – Clinical Problem Solving

Gregory M. Garrison,
Denise M. Dupras,
Stephen P. Merry,
Alan J. Smith

Chapter contents
  Making Clinical Decisions 124
  Focusing the Question 125
  Finding the Evidence 125
  Incorporating Patient Preferences 127
  Conclusion 129

Key Points
      Taking care of patients requires clinical decision-making skills.
      Most physicians rely on “mindlines” formed by previous knowledge and experience.
      A lag exists between the publication of new evidence and its incorporation into clinical practice.
      Clinicians should use evidence-based medicine techniques to update their mindlines.

During a 15-minute follow-up visit for her diabetes, Mrs. Smith, a 78-year-old white patient who has a history of well-controlled type 2 diabetes mellitus, hypertension, asthma, and mild dependent edema, requests a refill of her hormone replacement therapy (HRT). Glancing at her chart, you note that she has been taking 0.625 mg daily of conjugated estrogen (Premarin) since a hysterectomy for excessive bleeding at age …