Some thoughts on clinical judgement

Thus far I have recorded 8 podcasts for Annals on Call, 4 of which have already been published.  The term and concept of clinical judgement enters the conversations repeatedly.  Each podcast has had a different guest, yet in most of these conversations I have heard clinical judgement invoked.  What is clinical judgement?  Do we just use the term when we want to stray from protocol or algorithm?  I found this definition which gets us part way to an understanding. For purposes of description, it can be considered the sum total of all the cognitive processes involved in clinical decision making. It involves the appropriate application of knowledge and individual expertise to the problem at hand. It would appear that this view of clinical judgment does not conflict with the tenets of EBM. But the problem arises (as we shall see later) because of the differing values attached to the different components of this cognitive process. From Clinical judgement & evidence-based medicine: time for reconciliation  Perhaps some scenarios will help.  An adolescent comes to the emergency department with a sore throat.  They have a negative rapid strep test but a Centor score of 4.  They “look sick”.  They tell you that this is the worst sore throat they have ever had.  They describe a rigor the previous night.  Do you follow a guideline that says that you need not give antibiotics, or do you consider the likelihood of a bacterial infection other than group A strep? ...
Source: DB's Medical Rants - Category: Internal Medicine Authors: Tags: Medical Rants Source Type: blogs