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Biomedical subjects

Richard Farrow

Publications and source records attributed to Richard Farrow.

4 recordsLinked to original sources
PubMed2003

Making sense of clinical reasoning: judgement and the evidence of the senses.

BACKGROUND: Close noticing, as keen discrimination and judgement between qualities, is a key capability for work in visual domains in medicine. This generic capability is normally assumed, and its specifics are left to develop through experience, as traditional apprenticeship in a specialty. Discrimination is an outcome of learning in the affective domain, and introduces a vital aesthetic dimension to clinical work that aligns with the interests of the medical humanities. An aesthetic approach to clinical reasoning, however, remains largely unexplored as an explicit focus for medical education. FRAMEWORK AND PRACTICE PARADOXES: We offer a framework for an explicit education of perceptual discrimination in the visual domain as a form of practice 'artistry', turning a surface 'looking' into a deeper 'seeing'. Such an education, however, raises certain paradoxes. While novices typically 'see' what they expect to see in visual images (sign and symptom), experts also make similar errors. Further, experts become familiar with the use of visual heuristics in diagnosis, such as vivid natural referents to aid in rapid pattern recognition in an encompassing diagnostic 'glance', yet this appears to defeat the first principle of describing what you see. Employing a model of imagination as a tacit form of knowing that 'prepares' and enhances perception, we suggest, however, that the judicious use of such heuristics can be positive. Moreover, the mechanics of the process of clinical judgement in visual domains can be detailed to inform educational agendas. A further paradox is that of experts using both idiosyncratic heuristics and protocol-driven practices, where these seem to offer contradictory approaches to gaining knowledge. We recognise this as a facet of medicine's inherent uncertainty, in the face of complex, ambiguous and unique material, that must be addressed through clinical education. CONCLUSION: We equate 'aesthetics' with 'sensibility' and describe clinical expertise as 'connoisseurship' of informational images. Such connoisseurship, a particular form of knowing, can, in turn, be defined as an aesthetic sensibility informing practice artistry. It can be articulated and analysed to provide a basis for educational enhancement. Connoisseurship is not a technical-rational procedure but is inherently paradoxical and such paradox may be valued as an educational resource, rather than seen as a hindrance.

Bible↗
PubMed2002

The "jaundice hotline" for the rapid assessment of patients with jaundice.

PROBLEM: Patients with jaundice require rapid diagnosis and treatment, yet such patients are often subject to delay. DESIGN: An open referral, rapid access jaundice clinic was established by reorganisation of existing services and without the need for significant extra resources. BACKGROUND AND SETTING: A large general hospital in a largely rural and geographically isolated area. KEY MEASURES FOR IMPROVEMENT: Waiting times for referral, consultation, diagnosis, and treatment, length of stay in hospital, and general practitioners' and patients' satisfaction with the service. STRATEGIES OF CHANGE: Referrals were made through a 24 hour telephone answering machine and fax line. Initial assessment of patients was carried out by junior staff as part of their working week. Dedicated ultrasonography appointments were made available. EFFECTS OF CHANGE: Of 107 patients seen in the first year of the service, 62 had biliary obstruction. The mean time between referral and consultation was 2.5 days. Patients who went on to endoscopic retrograde cholangiopancreatography waited 5.7 days on average. The mean length of stay in hospital in the 69 patients who were admitted was 6.1 days, compared with 11.5 days in 1996, as shown by audit data. Nearly all the 36 general practices (95%) and the 30 consecutive patients (97%) that were surveyed rated the service as above average or excellent. LESSONS LEARNT: An open referral, rapid access service for patients with jaundice can shorten time to diagnosis and treatment and length of stay in hospital. These improvements can occur through the reorganisation of existing services and with minimal extra cost.

Adolescent↗