Pediatric Informatics: Computer Applications in Child Health (Health ...

186 P.W. Dalrymple et al.
13.2.1 The Clinical Encounter
In a clinical encounter between a practitioner and patient and family, data about
the patient’s medical needs (clinical problems and diagnoses requiring resolution,
therapy and education) are elicited, collected and documented by the physician
(from history and physical examination) to formulate hypotheses and problem
lists (based on clinical knowledge and expertise). Interventions (diagnostic testing
and/or therapy) are guided by the clinician’s application of medical knowledge
( decisions based on the training and experience). 1
Within the clinical encounter, the clinician uses formal and informal knowledge
(Table 13.1) dynamically to make diagnostic and therapeutic decisions and may
have information needs during any part of the encounter. In many cases, informal
knowledge or resources (“tribal knowledge,” 3 consultation with a colleague) are
used, but frequently, formal sources of medical knowledge (textbooks, journal articles,
databases) and patient data (medical records) are needed to fill an individual
clinician’s data or knowledge gaps.
It is not sufficient to have access to information resources. Clinicians must also
have familiarity with tools and when (and how) to use them. Many practicing clinicians
have favorite and familiar resources that are kept at hand, 4 but need guidance
when those resources fail them in answering a question.
13.2.2 Recognizing and Prioritizing Information Needs
The first step in using information resources is recognition of an “information
gap” in personal knowledge (“what I don’t know”) that prevents effective problem
solving. Unrecognized personal information gaps may go unresolved 5 or may
be addressed by clinical decision support (guided choices and knowledge-based
prompts) and/or by educational programs. Once an information need is recognized,
other factors such as the urgency of patient need and the expectation that an answer
will be found may affect prioritization of consulting information resources. 6
Table 13.1 Types and formality of medical information 2
General medical knowledge Patient-specific data
Informal Stereotypes about types of patients
or practitioners
Undocumented information about
side-effects of particular drugs
or procedures
Formal Information contained in texts and
national databases
Causal models and general procedures
accepted throughout medicine
Knowledge about particular
patients
Practitioners’ shared impressions
about causality of local phenomena
Information in medical records and
hospital information systems