The Acute Mind

For & Against (Evidence Evaluation)

Definition

Very useful framework when balancing the pros & cons of a diagnosis but also management. Does the potential benefits outweigh any potential risks?

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How to Apply

Essentially, you are listing the pros & cons of any diagnosis or intervention. This will allow you to make a balanced decision on the most pragmatic & holistic approach in the patient’s best interests. As you will see from the clinical cases, medicine is rarely straightforward – each decision is seldom without its drawbacks (esp. in the elderly).

I often get asked when choosing not to investigate / intervene – how can you be confident of the consequences? What if you miss something bad? My response is via this framework – if you can clinically explain & justify your actions on balance in the patient’s best interests then you have probably done the right thing.

Remember – we can only make decisions with the available information at the time and hindsight bias should never be used to reprimand our actions. The classical example of a simple abdominal pain turning out to be cancer so every patient thereafter gets a CT.

I believe the beauty & also challenge of acute medicine is ‘making complete decisions with incomplete information!’