A Primer on Clinical Experience in Medicine: Reasoning, Decision Making, and Communication in Health Sciences

Mastery of quality health care and patient safety begins as soon as we open the hospital doors for the first time and start acquiring practical experience. The acquisition of such experience includes much more than the development of sensorimotor skills and basic knowledge of the sciences. It relies on effective reasoning, decision making, and communication shared by all health professionals, including physicians, nurses, dentists, pharmacists, physiotherapists, and administrators.

A Primer on Clinical Experience in Medicine: Reasoning, Decision Making, and Communication in Health Sciences is about these essential skills. It describes how physicians and health professionals reason, make decisions, and practice medicine. Covering the basic considerations related to clinical and caregiver reasoning, it lays out a roadmap to help those new to health care as well as seasoned veterans overcome the complexities of working for the well-being of those who trust us with their physical, mental, and spiritual health.

The book provides a step-by-step breakdown of the reasoning process for clinical work and clinical care. It examines both general and medical ways of thinking, reasoning, argumentation, fact finding, and using evidence. Outlining the fundamentals of decision making, it integrates coverage of clinical reasoning, risk assessment, diagnosis, treatment, and prognosis in evidence-based medicine. It also:

• Describes how to evaluate the success (effectiveness and cure) and failure (error and harm) of clinical and community actions
• Considers communication with patients and outlines strategies, successes, failures, and possible remedies—including offices, bedside, intervention, and care settings
• Examines strategies, successes, failures, and possible remedies for communication with peers—including interpersonal communication, morning reports, rounds, and research gatherings

The book describes vehicles, opportunities, and environments for enhanced professional communication, including patient interviews, clinical case reports, and morning reports. It includes numerous examples that demonstrate the importance of sound reasoning, decision making, and communication and also considers future implications for research, management, planning, and evaluation.

Milos JENICEK, MD, PhD, Canadian citizen, is currently holding a position as Professor (Part-Time) at the Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada. He is also Professor Emeritus at the University of Montreal and he holds an adjunct position of Professor at McGill University Faculty of Medicine, Montreal, Quebec, Canada. In 2009, he was elected Fellow of The Royal Society of Medicine, London, UK.

Milos Jenicek received his basic education at Charles University, Prague (MD, 1959), a graduate degree in 1965 (PhD) and later a postgraduate clinical training at McGill University Teaching Hospitals. He is a licentiate of the Medical Council of Canada (LMCC), a Fellow of the Royal College of Physicians and Surgeons of Canada (FRCPC), a specialist of the Province of Quebec (CSPQ) and holds a regular permit to practice medicine in Ontario and Quebec.

He contributes to the evolution of epidemiology as a general method of objective reasoning and decision making in medicine. To further enhance his teaching and research, he has committed himself to short sabbaticals during which he visited Harvard and Johns Hopkins, Yale, North Carolina at Chapel Hill and Uniformed Services at Bethesda Universities. He also lectured and visited numerous institutions in Hong Kong, Singapore, Japan, South Korea, Portugal, Brazil, France and Switzerland. He has been a visiting professor to various universities and governments. Earlier in his career, three years of University teaching and field practice of preventive medicine and public health in North Africa (1965-1968) has given him valuable insight and understanding of the realities in this part of the world.

During his term as Acting Chairman of the Department of Social and Preventive Medicine, University of Montreal (1988-1989), he founded the graduate program in Clinical Epidemiology at the University of Montreal, his core course being also part of the graduate program at McGill University. Until 1991, he was member of the Board of Examiners of the Medical Council of Canada (Committee on Preventive Medicine). In 2000, he was invited as External Examiner by the Kuwait University. Also, Milos Jenicek is a consultant to various national and international public and private bodies, Editorial Consultant for the Journal of Clinical Epidemiology and the Case Reports & Clinical Practice Review and Honorary Editorial Board Member of Evidence-Based Preventive Medicine.

In addition to numerous scientific papers, Milos Jenicek has published thirteen textbooks: Introduction to Epidemiology (in French, 1975). Epidemiology. Principles, techniques, applications (in French with R. Cléroux, 1982, and in Spanish, 1987), Clinical Epidemiology, Clinimetrics (in French with R. Cléroux, 1985), and Meta-Analysis in Medicine. Evaluation and Synthesis of Clinical and Epidemiological Information (in French, 1987), by the James Lind Library recognized first textbook of meta-analysis in medicine. The Epidemiology. The Logic of Modern Medicine" (EPIMED International,1995) was also published in Spanish (1996) and Japanese (1998). His sixth book, Medical Casuistics. Proper Reporting of Clinical Cases" (in French, 1997) is again produced jointly by Canadian (EDISEM) and French (Maloine) publishers. Clinical Case Reporting in Evidence-Based Medicine (Butterworth Heinemann,1999) appears again as an expanded second edition in English (Arnold, 2001), Italian (2001), Korean (2002) and Japanese (2002). His Foundations of Evidence-Based Medicine was published in 2003 by Parthenon Publishing/CRC Press. The tenth Evidence-Based Practice. Logic and Critical Thinking in Medicine (with D Hitchcock) was released by the American Medical Association (AMA Press, 2005) as well as his A Physician’s Self-Paced Guide to Critical Thinking (AMA Press, 2006) and Fallacy-Free Reasoning in Medicine. Improving Communication and Decision Making in Research and Practice (AMA Press, 2009). His Medical Error and Harm. Understanding, Prevention, and Control was just released (2011) by CRC Press/Taylor & Francis.

Current interests: Development of methodology and applications of logic, critical thinking, decision making and communication in health sciences, enhancement of evidence-based medicine and evidence-based public health, health policies and program evaluation, decision oriented (bedside) clinical research.

Contact by e-mail: jenicekm@mcmaster.ca