Saul J. Weiner, MD; Alan Schwartz, PhD
Potential Conflicts of Interest: None disclosed.
Weiner S., Schwartz A.; The Need for Biomedically and Contextually Sound Care Plans in Complex Patients. Ann Intern Med. 2010;153:620. doi: 10.7326/0003-4819-153-9-201011020-00019
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Published: Ann Intern Med. 2010;153(9):620.
A finding of our study that surprised us was that although physicians who spent more time with patients were more likely to probe for biomedical or contextual red flags, they were not more likely to provide contextually appropriate care. For example, in the case of a patient whose health literacy problems accounted for an inability to dose his diabetes medications correctly, physicians more often identified the literacy issue during longer visits but were not more likely to appropriately intervene. Physicians who intervened, however, did not on average have longer visits. Physicians who avoid contextual errors seem to think differently, considering context not as an afterthought but instead as a part of the clinical reasoning process. We recently studied an educational intervention that suggests such reasoning processes can be effectively taught (1).
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