Question

What is the role of doctors as evaluators? and how can they utilize evaluation in their career

Define and describe which one of the terms below would relate to the role of a doctor in the healthcare field?

evaluand, evaluator, and the evaluation commissioner.

Define Evaluative judgment and provide 2-3 examples of how this would be useful for doctors?

Answer 1

1. What is the role of doctors as evaluators? And how can they utilize evaluation in their career

Ans:-

The purpose of the evaluation is for the physician to assess your medical symptoms related to your accident, injury, or illness. The doctor will evaluate your ability to function and respond physically and/or mentally to various tasks. They may make recommendations or restrictions on your ability to perform daily activities at home, work, and in recreation.

Because the primary responsibility of the independent medical evaluator is to provide a service for the hiring third party and not for the patient, legal and ethical concerns may arise during an IME that would not typically arise within the context of a standard physician-patient relationship.

The Role of the Doctor Consensus statement

Doctors alone amongst healthcare professionals must be capable of regularly taking ultimate responsibility for difficult decisions in situations of clinical complexity and uncertainty, drawing on their scientific knowledge and well developed clinical judgement. The doctor's role must be defined by what is in the best interest of patients and of the population served.

Based on the definition of the role of a medical doctor proposed by the International Labour Organisation it is agreed that:

"Doctors as clinical scientists apply the principles and procedures of medicine to prevent, diagnose, care for and treat patients with illness, disease and injury and to maintain physical and mental health. They supervise the implementation of care and treatment plans by others in the health care team and conduct medical education and research."

All healthcare professionals require a set of generic attributes to merit the trust of patients that underpins the therapeutic relationship. These qualities include good communication skills, the ability to work as part of a team, non-judgemental behaviour, empathy and integrity. In addition to possessing these shared attributes doctors must be able to:

Assess patients' healthcare needs taking into account their personal and social circumstances

Apply their knowledge and skills to synthesise information from a variety of sources in order to reach the best available diagnosis and understanding of the patient's problem, or to know what steps need to be taken to secure such an outcome

Support patients in understanding their condition and what they might expect, including in those circumstances when patients present with symptoms that could have several causes identify and advise on appropriate treatment options or preventive measures

Explain and discuss the risks, benefits and uncertainties of various tests and treatments and where possible support patients to make decisions about their own care.

The nature of these core requirements emphasises the need to select those with the appropriate attributes for training.

Medical undergraduate education must provide a strong grounding in relevant science and in clinical practice as well as providing opportunities to develop an appreciation for research. Doctors must have the ability to assimilate new knowledge critically, have strong intellectual skills and grasp of scientific principles and be capable of dealing effectively with and of managing uncertainty, ambiguity and complexity.

They must have the capacity to work out solutions from first principles when the pattern does not fit. All doctors must be demonstrably committed to reflective practice, monitoring their contribution and working continually to improve their own and their team's performance.

Doctors must all be committed to playing a part in the education and support of the next generation of medical practitioners and of facilitating the advancement of evidence based practice.

The doctor needs to be capable of assessing and managing risk; this requires high level decision making skills and the ability to work outside defined protocols when circumstances demand. Doctors must also be able to make informed decisions about when supportive care is more appropriate for the patient than intervention.

The doctor must possess the ability to work effectively as a member of a healthcare team, recognising and respecting the skills and attributes of other professions and of patients. Patients with long term and disabling conditions are particularly likely to be experts in their own condition and should be supported to keep as healthy and independent as possible.

All doctors have a role in the maintenance and promotion of population health, through evidence based practice. Some will enhance the health of the population through taking on roles in health education or research, service improvement and re-design, in public health and through health advocacy.

Doctors have a key role in enhancing clinical services through their positions of responsibility. Some will move on from clinical leadership and management to leadership roles within organisations at various levels - service, institutional, national and international.

The role of the doctor is changing and will continue to change alongside the needs and expectations of patients. Patients are increasingly better informed and act as partners in their own healthcare. The doctor serves as advisor, interpreter and supporter in this endeavour.”

Physician manager's many responsibilities, monitoring and changing physician behavior in other words, evaluating doctors' performance is one of the most important and most complex.

How does one track and measure changes in physician behavior and the effects they have on the practice of medicine? The process doesn't lend itself easily to statistical analysis, and day-to-day observation of a doctor's practice isn't practical. Physician performance evaluation is often mentioned in lectures and articles dealing with managed care, physician compensation and the formation of physician organizations yet it's rarely described in detail. Very little published literature directly addresses the process, particularly in the journals physicians typically review.

2.Define and describe which one of the terms below would relate to the role of a doctor in the healthcare field?

Ans:- Evaluator defines.

Independent expertise from private companies or public institutions. Doctors have many duties toward their patients. Their responsibilities cover their own actions, as well as orders they give to their assistants, such as nurses, medical students and residents.

Here are the doctor's obligations towards patients: Diagnosing and Treating Patients In legal terms, doctors have an obligation of means toward their patients, not an obligation of result.

This means that they have to take appropriate steps available to make the right diagnosis, provide treatment and follow-up on their patients' progress. Doctors must base their actions on up-to-date scientific information and use recognized treatments in the right way.

They must treat their patients attentively and conscientiously.

Doctors must recognize their own limits: in case of doubt, they must get information from other people or refer patients to specialists.

The duty to treat patients includes the duty to prescribe the right medication, tell patients about the advantages, disadvantages, risks and alternatives regarding a proposed treatment or operation, and provide adequate follow-up to the patient within a reasonable amount of time.

For example, after a treatment, a doctor must provide the medical follow-up required by the patient's state of health, or at least make sure that a colleague or other professional follows up.

The doctor's duty is toward the patients themselves, the people who make decisions on behalf of patients, or the parents of children under the age of 14.

Doctors must explain the chances of success and the risk of failure of the suggested treatment, keeping in mind the patient's specific condition.

Doctors must also inform their patients about the possible negative effects of a treatment. However, it is impossible for a doctor to talk about all of the possible risks; doctors must tell their patients about the foreseeable risks, in other words the risks that are most likely to occur. Doctors must also tell patients about any rare risk that could have serious consequences.

The extent of the duty to provide information depends on the circumstances and the patient in question.

For some types of treatments, doctors are required to give more complete and specific information about the risks. This is the case, for example, with purely experimental treatments as well as treatments that are not aimed at curing an illness or injury, like some types of plastic surgery. In these cases, doctors must tell patients about all possible and rare risks.

Obtaining the Patient's Free and Informed Consent The reason behind the duty of doctors to provide information to patients is to give patients all the information they need to make free and informed decisions with full knowledge of the facts about the treatment and care offered. When a patient agrees to treatment or care, this is called consent.

The duty to get the consent of patients is a continuous process. This is why patients must be kept informed about any new information about their states of health and the treatments they are receiving.

Respecting Confidentiality

Doctors have a duty to respect their patients' confidentiality. This is sometimes called the duty of professional secrecy.

This duty covers both the information patients tell their doctors and any facts doctors discover about their patients as part of the doctor-patient relationship.

Professional secrecy belongs to the patient, not the doctor. Doctors cannot reveal what their patients tell them, unless their patients waive the confidentiality of the information or if the law allows it. For example, the Public Health Act says that certain diseases must be reported to public health agencies. Also, doctors can reveal some confidential information when they have very strong reasons to do so related to the health or safety of the patient or people close to the patient.

3. Define Evaluative judgment and provide 2-3 examples of how this would be useful for doctors?

Ans:-

Evaluative judgement is the capability to make decisions about the quality of work of oneself and others. We explore evaluative judgement within a discourse of pedagogy rather than primarily within an assessment discourse, as a way of encompassing and integrating a range of pedagogical practices.

Difference between evaluation and judgement

Evaluations are positive. Judgments are negative. Evaluations help you decide what you want more of in your life and create a sense of connection. Judgments can create confusion and separate you from others. Evaluations are expansive; judgments are constrictive. Evaluations give you freedom of choice; judgments limit your behaviour and the behaviour of others. Evaluations merely state what "is" in a neutral, objective manner. Judgments indicate an opinionated, subjective value. Evaluations can be seen as a mental or a scientific approach, while judgments are emotional and often suggest a moral, self-righteous approach.

Example- Attitudes such as satisfaction involve evaluative judgments (i.e., one's summative evaluation of the organization), whereas commitment, as defined here, does not involve an affect-based evaluative aspect. Physicians, nurses, and other clinicians readily acknowledge being troubled by encounters with patients who trigger moral judgments. For decades social scientists have noted that moral judgment of patients is pervasive, occurring not only in egregious and criminal cases but also in everyday situations in which appraisals of patients' social worth and culpability are routine. There is scant literature, however, on the actual prevalence and dynamics of moral judgment in healthcare. The indirect evidence available suggests that moral appraisals function via a complex calculus that reflects variation in patient characteristics, clinician characteristics, task, and organizational factors. The full impact of moral judgment on healthcare relationships, patient outcomes, and clinicians' well-being is yet unknown. The paucity of attention to moral judgment, despite its significance for patient-centred care, communication, empathy, professionalism, healthcare education, stereotyping, and outcome disparities, represents a blind spot that merits explanation and repair. New methodologies in social psychology and neuroscience have yielded models for how moral judgment operates in healthcare and how research in this area should proceed. Clinicians, educators, and researchers would do well to recognize both the legitimate and illegitimate moral appraisals that are apt to occur in healthcare settings.

Example- Renate Justin's new patient with emphysema revealed during her intake history that she was an unrepentant Nazi anti-Semite who had supervised slave labourers during the war. Justin, a Jewish family physician, struggled through the turmoil of her feelings and duties before the second visit.

"I had decided that if she stayed with my practice, I could probably be a skilled and trustworthy physician to her. Intellectually, I had concluded that my job as a doctor was to take care of her, regardless of her history. I felt that I could achieve this: I could treat her emphysema and suppressor control my moral outrage. What I did not know was whether I could be compassionate."

Clinical Judgement

Nurses must deal with a broad range of issues related to the condition of each patient, including complications and improvements, as well as annotations to clinical records and communications with physicians. As such, the nurse’s judgement is at the heart of care delivery. Judgement guides action and decisions, not only of the nurse, but also of physicians and other care providers. It is therefore essential for the nurse to have observational and reasoning skills in order to make sound, reliable clinical judgements.

It is difficult to come up with a unanimous definition for clinical judgement, a concept which is critical to the nursing profession as a result of its outcomes. Many authors have come up with thoughtful definitions. Nonetheless, the topic is complex, so humility and simplicity are required to grasp this concept.

A professional is an individual who has specific knowledge of a subject which allows him to be accountable and to manage serious human matters. The professional must be able to understand the problems at hand. He must have a clear understanding of their elements and effects in order to come up with appropriate solutions. The professional must possess a blend of sensory and intellectual abilities to make clinical judgement. She needs to understand the mechanisms and the significance of the case at hand.

Clinical judgement is not limited to identifying a problem; it also involves seeking a broad range of possibilities. According to Clémence and Martine Dallaire, clinical judgement “enables the individual to recognize the aspects of a given situation, to foresee possible interventions to stabilize the condition of a patient, to articulate the nursing perspective for all situations which require care delivery, to determine which areas leave room realistically for personal improvement and development, and to make elaborate qualitative distinctions in critical areas of the profession.”

There are many examples of physicians using treatments inappropriately, despite clear evidence about the circumstances under which the benefits of such treatments outweigh their harms. When such over- or underuse of treatments occurs for common diseases, the burden to the healthcare system and risks to patients can be substantial. We propose that a major contributor to inappropriate treatment may be how clinicians judge the likelihood of important treatment outcomes, and how these judgments influence their treatment decisions. The current study will examine the role of judged outcome probabilities and other cognitive factors in the context of two clinical treatment decisions: