Anterior Cruciate Ligament, Nicole, Behavioral Health discussed on Health Hats, the Podcast


And we're faced with decisions decisions and the decisions can be ranging from take a pill that's a prescription take a pill l.. That isn't a prescription having therapy changing your behavior. I'm sure there's more than just not thinking of right now. And so is clinical Nicole decision support about any of that. Yeah it's about thinking about those options but being presented with options on the basis of evidence. So the idea behind Decision support is that there is some way to synthesize cise. The evidence that's out there apply to a specific context person a situation group any of those things or all of them taken together and then provide a set of recommendations that also have some documented support so characteristics that help a person person think through those options and perhaps choose a decision that You know maybe this is the first visit. Maybe this is the first decision decision you're making and they're five options and so you're trying the first of these options. Maybe it's the lowest impact option or the the the lightest. Lift it kind of option and you light us. Lift meeting like the least disruptive to your life yet that the like an amputation would be a huge or okay. Yeah and maybe in terms of pain for example. It's it's doing therapy before trying. Hang any therapeutic. So Fox is clinical decision support always with a patient and a medical person like a doctor or nurse practitioner or PA.. Or is it also with a chiropractor with an acupuncture nutritionist. You know other healthcare licensed healthcare professionals or is it mostly medical well traditionally. It's been thought of as something that is. Delivered to the clinician on a clinician makes the decision so it's been in the medical domain but that doesn't mean that that's where it should remain and in fact it's pretty clear that it shouldn't uh-huh and you know recent work we. We certainly see it moving into the behavioral health domain and whether that then extends to all of the services and community based organizations that are providing other kinds of social words. You know absolutely it seems like it's it's appropriate when you say Behavioral Health that's addiction treatment and mental health services for example. Yeah you you don't have to answer this if you don't want to. But how have you used CD s in your life like outside of your professional role more like your personal role will or as a family member. Yeah absolutely so I use. It's not a formal form of clinical. Doesn't support we all use clinical decision support. We just don't don't necessarily call it that or to give it that name but I think it's it's sort of looking for information an whether electronically or talking to friends or family or to community members to sort of look for good options maybe or look for problems problems or risks and so for example the most common and the most prevalent. CDs today is really looking at. What's the right drug for me to take for? Are this new symptom that I have. Can I take something homeopathic. Can I A ticket with this other drug that I normally take. Is there going to be a problem do you do. I have any allergies to this medication that I need to be aware of before I take it and you know. Can I recommend it for a friend WHO's Aspirin allergic or something that okay. Okay and so I'm thinking about like how I ve used it do. Do I wanna take the cholesterol medication. Do I WANNA colonoscopy. What medicine do I take for my multiple Sclerosis prosise so those are all right for clinical decision support? Yeah absolutely okay. Clinical decision support for has a a manual process meaning a human process that then technology gets gets applied to because time is so short. And there's just so much information that any one human being can't really take it in. Yeah I have an example. My husband had a knee injury from in early in his life and the injury. Wasn't you know there was no specific treatment treatment. It was a tear on a not a complete tear but like a stretch of his. ACL's anterior cruciate ligament and he had done a little but if therapy after the news never the same again which I think is not that unusual for knee. Injuries like that but he was still strong and having no real pain and no difficulty walking. Then you know in our late forties. Something was throwing a wrench in the works. There was something literally getting a a of his knee joint and so we spent a lot of time talking about it because the outcomes for knee surgery are really poor. They're they're actually kind of terrible arable. So most of the time you go in you have something maybe cleaned out and some repair done. But then if you're a person who develops arthritis the arthritis will sort of come back back with a vengeance. We knew that he had from the thumbs. We knew that he had very little cartlidge. We knew that he he was lucky to not be in chronic pain but we also knew that there was sort of the ghost or cloud of it of what looked like random piece floating so finally after I think four opinions and lots of research and knee saying consistently. I really don't want to have surgery on his knee because the outcomes just don't look good we finally got someone who agreed to just go in and take a look and see if there are any floating pieces could be removed and in fact I think this is like commonly only called joint mouse but there was the spooning piece of cartilage. Probably from the early injury that was she can lose during. We were playing around in Baltimore more on this piece of sculpture and he landed on the knee after that it was just floating and anyway they removed to join mice from the and closed him up and sent him home and numerous scraping or cleanings been much better. So what's the clinical decision decision support of that. Did you say already or did I miss it. We did get I think four different orthopedic surgeon opinions I Z.. We went to over a long period of time. We looked at all the evidence both from a research point but also sort of from what is out there in popular repress about how well people do and how well they feel after you need surgery and the overwhelming opinion was you know that it. It's it works for for some and it doesn't work at all for for the same number so it's fifty fifty chance that you'll have any success and I feel schizophrenic in the sense that sometimes I think about what you're saying and I just keep hearing. Okay this is humans doing work to learn more and then I sit around these tables where it seems like it's about the technology. She of clinical decision support. I understand what you went through to to figure out what what your options were and then make a selection and it sounds all humid. Yeah what's the technology. Part of that will the situation that I'm describing the sort of the situation at present however there is a lot of good evidence if it had been available to even even one of the clinicians we saw would have been presented to us and examined carefully. And it's not rocket science. The the evidence is pretty solid. It's pretty robust and could have really been clear early on without four. Visits without of consternation consternation you know what our options were and thought about a step wise approach.

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