Suleimenova Balkhiya Abdulbakhiyevna, Candidate of Medical Science, Expert of Public Health, teacher of specialty courses at “Higher Medical College” State Municipal Enterprise on the Right of Economic Management, Kazakhstan
ABSTRACT
Objective: The objective of this article is to demonstrate the importance of development of clinical thinking in practical activity of a health care worker.
Methods: review article performed in dialectical process between corresponding literature, theoretical basis and reflection.
Outcomes: properly established risk management at medical organization is based on a health care having skills of clinical thinking. Clinical thinking shall be shaped with students at early stages of studying.
Key words: clinical thinking, education
Introduction
This article presents rationale for establishment of clinical thinking with students of educational organizations of the healthcare system. Properly and timely established clinical thinking allows avoid medical errors in practice in the future.
Since medical activity is associated with legal aspects of liability of health care worker, it is imperative to establish a national system for assurance of quality of medical services which comes from a systematical and regular basis of study of the national and international experience, development of scientifically grounded recommendations for the system of medical education, managers of all levels of management in the healthcare system and practicing health care workers.
In the current context, a person is a target for increscent information streams, which, as a result of rapid development of advanced technologies, incline to take sound decisions within a short time.
A health care worker has to work under the same conditions, however, opposed to other specialties, life and health of a patient often depends on correctly and timely decision taken by him.
Personality formation with a clinician is a complex, multistage and ongoing process based on combination of advanced teaching technologies and traditions of the national medical school. At the same time, it should not be forgotten that a mid-level health care worker often has to make the only possible decision independently at the patient’s side or in an ambulance vehicle.
Clinical thinking is a substantially specified process of dialectical thinking which provides integrity and completeness to medical expertise.
Unfortunately, there have been cases in medical practice where a qualified diagnostics of a disease was not run due to a lower professional level of a healthcare worker, as a consequence, a patient was not provided by proper treatment and disease prevention.
In view of the global nature of medical errors, in January 2002, the Executive Board of the World Health Organization (WHO) examined a special resolution “Quality of Public Health Services and Patient Safety” and approved the Strategy for improvement of patient safety, where it scheduled basic measures to improve the quality of medical aid to people.
The specificity of clinical thinking is included in the fact that diagnosis must consider some key factors. For instance, disease progression is influenced by the disease itself, individual characteristics of the organism of a patient, as well as by medical services.
When establishing a clinical diagnosis and making clinical decision, a healthcare worker must consider sex and age of a patient, his profession, hereditary background, burden of chronic diseases, as well as his place of residence (city resident/rural resident).
Individual characteristics of a patient also influence capability to conduct separate diagnostic tests and procedures, for instance, presence of allergic background against pharmaceuticals.
Besides, we must consider characteristics of the disease of a patient (acute process or chronic disease exacerbation, expressed or unexpressed symptoms and syndromes etc.), and conduct differentiation between other alike diseases.
It is important to understand that disease symptomatology is never complete in the real world as it is stated in guidelines. In some cases, symptoms essential for diagnostics may be absent: sometimes acute hepatitis may runs without icterus. Even peritonitis with patients of older age may be manifested by collapse only. With patients of the same age, septic myocarditis sometimes in not accompanied by fever.
By the late 19th century, a work style of a physician included in observation of a patient and his examination according to the traditional scheme has established which is as follows: interrogation first, then physical examination and paraclinical examination next.
However, in radically different conditions, происходит a process for establishment of a diagnosis in cases of outcall of emergency medical care specialists takes place. In some cases, they have to make decisions without interrogation, only being based on examination of a patient and measurement of hemodynamics indicators at the place of call, when the patient is unconscious and no relatives are nearby.
For sound establishment of clinical thinking, we must make use of the international and national expertise of practical activity of healthcare workers, which must be systemized at a research organization for study of the issues of quality assurance in the public health sector of our country.
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