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[e-drug] Information on clinical guidelines (4)

E-DRUG: Information on clinical guidelines (4)
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In the last decade a number of educational programmes have been
developed to improve the teaching of rational pharmacotherapy,
standard clinical or treatment guidelines but no serious efforts are
done for any rational approach to diagnose with minimal
investigations. As a part of clinical guidelines, criteria for
selection of most appropriate investigation/s for diagnosis should
also be designed.

Structured training in rational approach for clinical investigations
is relatively uncommon. In many medical schools teaching is
characterized by the transfer of knowledge about diagnosis and drugs,
rather than by the skill to treat patients. Medical students should
develop, at some time in the course of their studies or early in their
career, a set of P-Investigations (like the concept of P-Drugs) which
they will use regularly from then on. Usually, the choice of
investigations is  made on irrational grounds, e.g. by copying
the prescribing behaviour of clinical teachers or peers without
considering alternatives or knowing how to choose between them.
Doctors are subject to many influences on their prescribing or
ordering of investigations including scientific publications in favour
of a particular investigation, commercial information and patient
pressures.

Logical structure to guide teachers and students through the process
of rational approach of diagnosis particularly in selection of
specific investigation from the long list of investigations is
probably beneficial in itself. Medical students need to be trained in
additional, skills necessary to apply the method successfully in
rational choice of investigations.

There is a need of teaching based on rational approach to clinical
investigations, which is possible within the structure of a
traditional (non problem-based) curriculum. We must have most logic
based flowcharts or algorithm in all investigations for diagnosis. But
at the same time there is a need to update all available
investigational algorithms periodically.

Syed Ziaur Rahman
Department of Pharmacology
Jawaharlal Nehru Medical College
AMU, Aligarh 202002, India
Telephone: +91-9358259740



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