Problem Solving Strategies and Decision Making in Health Care - Essay Example

?Diagnostic Problem Solving Critical reflection on a range of problem solving skills in health assessment requires you to compare and contrast the many approaches to problem solving (Diagnosis) in health assessment. Problem solving and decision making are crucial paradigms of clinical reasoning. Each of these paradigms requires assumptions and reasoning. The choice of the strategy to be applied in a diagnostic problem solving is dependent on the severity of the case and the knowledge of the experts involved. The essay discusses the strategy of problem solving when making a diagnosis decision in paramedics context through focus on the patients with chest pains. Problem Solving Strategies The strategies for problem solving include hypothesis testing, pattern recognition, specific instance or general prototypes. Hypothesis Testing and Pattern Recognition Problem solving depends on the clinician’s mastery in a certain field i.e. Chest pains (Patel and Groen, 1986). This is contrary to the hypothetico-deductive model of clinical reasoning that alludes that inexperienced paramedics use hypothetical testing (Chapman and Sonnenberg, 2000; Patel and Groen, 1986). The variability of the efficiency of clinicians’ actions indicates that they do not apply the same reasoning and procedures when undertaking their roles. Hypothesis testing is a crucial process applied by experienced clinicians in difficult situations that requires application of personal expertise. By Specific Instance or General Prototypes A new case is often categorised based on matching the various cases to the specific instances or related to an abstract prototype. In the specific instance, the case is normally categorised through reference to the memories of the previously occurrences (Brooks, Norman and Allen, 1991; Rote and Dunstan, 2011). This principle is supported by the fact that clinical diagnosis is normally affected by the context. For instance, the viscosity of the phlegm produced when a patients coughs is crucial in the determination of clinical diagnosis. The prototype model holds the idea that the clinical experience leads to the construction of the mental models, abstractions and prototypes (Bordage, 1999: Brooks, Norman, and Allen, 1991). For instance, the model can be applied in the identification of the additional methods that enhances a clinical picture and relate the findings to the general concept of the case. Decision Making Diagnosis as an Opinion Revision Application of the theory of decision making in selecting a diagnosis involves updating the opinion with the clinical evidence (Hunink et al, 2001). The most viable theory in this case is the Bayes theory whereby the probability applied is related to the known dynamics of the prevalence of the condition and the clinician’s subjective impression (Schwartz, 2001; Elstein and Schwarz, 2002). Estimating the occurrence of a problem involves of the estimation of probability. Errors Encountered In the Estimation of Probability One of the errors is related to availability. Clinicians may sometimes overestimate the frequency of the invisible events while underestimating other crucial events that are difficult to recall. For instance, diseases that receive considerable attention from clinicians are thought of occurring more prevalently than the ones that receive less. The psychological aspect of the principle of availability is clinically exemplified by the existence overemphasis of the rare conditions as they are normally memorable compared to the rare ones. Another error encountered is the representativeness that estimates the disease probability through judging how similar case is to a prototype or diagnostic category (Grigorenko, 2009; Walsh, Crumbie and Reveley, 2001). When treating a patient, the clinician is supposed to perform superiority or apply superior skills compared to the novices and intermediates. The paramedics are required to understand the medical processes used in the diagnosis and treatment of the problem. For instance, the patient is supposed to be undertaken thorough evaluation of the problem that they are experiencing e.g. chest pain. It is crucial for the paramedic to undertake a heart attack diagnosis which enables them to be taken to a cardiac categorisation suite or admitted for coronary care for intensive medical therapy (Nallamothu, 2001; Koyuncu, Yilmaz and Soysal, 2007). The clinical expert handling the chest pain problems applies two components of clinical problem solving separately although it is impossible to separate them in practice (Barrows and Pickell, 1991; Bosner, Becker and Haasenritter, 2009). The first component is content i.e. the clinician is supposed to have a rich and extensive knowledge on medical problem-solving. The other component is the real application of the knowledge on treatment and diagnosis. In cases where the cause of the disease is not ascertained the patient should be admitted for comprehensive medical check-up. Some of the problem-solving strategies that such patients undergo in the hospitals include specialised blood tests, monitoring and testing the stress levels. This is carried out through ultrasound sound or nuclear imaging (Gaissert, Piyavisetpat, Mark, 2009). This provides the paramedic with the required information to either discharge the patient or recommend them for further medical check-up. The clinicians are required to work cooperatively with other members of the medical fraternity to ensure that the diagnosis or treatment methods they use are efficient and effective in improving the health of the patients. Understanding the severity and urgency of the situation is also crucial for the paramedics involved in the formulation of the efficient strategies for curbing chest pains. Another consideration that should be taken into account when making a diagnostic or treatment decision is the technology to be applied. For instance, the cause of the chest problems can be determined through the application of 64-slice CT scanner (Verdon, Herzig and Burnand, 2008). Conclusion The strategies for problem solving include hypothesis testing, pattern recognition, specific instance or general prototypes. The decision-making approaches consider diagnosis as the opinions with imperfect and inconclusive information. The two main errors encountered in the estimation of probability include availability and representativeness. References Barrows, H.S. & Pickell, G.C. (1991) Developing clinical problem-solving skills: a guide to more effective diagnosis and treatment, New York: W.W. Norton. Bordage, G. (1999) ‘Why did I miss the diagnosis? Some cognitive explanations and educational implications’ Acad Med; vol. 74, no. S138–S142. Bosner, S., Becker, A. & Haasenritter, J. (2009) ‘Chest pain in primary care: epidemiology and pre-work-up probabilities’ Eur J Gen Pract, vol. 15, no. 141. Brooks, L.R., Norman, G.R. & Allen, S.W. (1991) ‘Role of specific similarity in a medical diagnostic task’ J Exp Psychol Gen, vol. 120, pp. 278–287. Chapman, G.B. & Sonnenberg, F. (2000) Decision making in health care: theory, psychology, and applications, New York, Cambridge University Press. Elstein, A.S. & Schwarz, A. (2002) ‘Clinical problem solving and diagnostic decision making: selective review of the cognitive literature’ BMJ, vol. 324, pp. 729-732. Gaissert, H.A., Piyavisetpat, N. & Mark, E.J. (2009) ‘Case records of the Massachusetts General Hospital. Case 14-2009. A 36-year-old man with chest pain, dysphagia, and pleural and mediastinal calcifications’ N Engl J Med. Vol. 360, no. 1886. Grigorenko, E. (2009) ‘Dynamic Assessment and Response to Intervention’ Journal of Learning Disabilities, vol. 42, no. 2, pp. 111-132. Hunink, M., Glasziou, P., Siegel, J., Weeks, J., Pliskin, J., Elstein, A.S. et al. (2001) Decision making in health and medicine: integrating evidence and values, New York, Cambridge University Press. Koyuncu, N., Yilmaz, S. & Soysal, S. (2007) ‘An unusual cause of chest pain: foreign body in the oesophagus’ Emerg Med J, no. 24:e1. Nallamothu, B.K., Saint, S., Kolias, T.J. & Eagle, K.A. (2001) Clinical problem-solving. Of nicks and time. N Engl J Med; 345:359. Patel, V.L. & Groen, G. (1986) ‘Knowledge-based solution strategies in medical reasoning’ Cognitive Science, vol. 10, pp. 91–116. Rote, J. & Dunstan, D. (2011) ‘The Assessment and Treatment of Long-Standing Disruptive Behaviour Problems in a 10-Year-Old Boy’ Clinical Case Studies, vol. 10, no. 4, pp. 263-277. Schwartz, A. (2001) Nomogram for Bayes's theorem, viewed 5 Mar 2013 from . Verdon, F., Herzig, L. & Burnand, B. (2008) ‘Chest pain in daily practice: occurrence, causes and management’ Swiss Med Wkly, vol. 138, no. 340. Walsh, M., Crumbie, A. & Reveley, S. (2001) Nurse practitioners: clinical skills and professional issues, Oxford, Butterworth- Heinemann Read More