Polarities in Clinical Thinking and Practice

John Z Sadler

doi:10.1001/journalofethics.2017.19.2.ecas1-1702

Polarities in Clinical Thinking and Practice

AMA J Ethics. 2017 Feb 1;19(2):141-146. doi: 10.1001/journalofethics.2017.19.2.ecas1-1702.

Author

John Z Sadler¹

Affiliation

¹ Daniel W. Foster, MD Professor of Medical Ethics and a professor of psychiatry and clinical sciences at the University of Texas Southwestern Medical Center in Dallas, and an attending psychiatrist at the affiliated Parkland Behavioral Health Center and an ethics consultant for Parkland Health and Hospital Systems.

PMID: 28225694
DOI: 10.1001/journalofethics.2017.19.2.ecas1-1702

Abstract

This analysis of a case of a bereaved patient that poses two treatment options-watchful waiting or medication-focuses on five "polarities" in clinical practice: (1) the normal and the pathological, (2) the individual and the diagnostic collective, (3) the primary care physician and the consultant, (4) the expert and nonexpert, and (5) the moment and the process. These polarities can accentuate ethical problems posed by this case, for example, by creating stark contrasts that mask the complex contexts of care and characteristics of patients. These stark contrasts can create false dilemmas that may obscure simpler, shared decision-making solutions. Alternatives to conceiving cases in terms of polarities are discussed.

Publication types

Case Reports

MeSH terms

Aged
Bereavement*
Clinical Decision-Making*
Consultants
Decision Making*
Depression / diagnosis*
Depression / drug therapy
Grief*
Humans
Male
Medical Overuse
Medicalization
Physician-Patient Relations*
Physicians
Thinking
Watchful Waiting