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  • Cited by 1
  • Print publication year: 2012
  • Online publication date: June 2012

1 - “It's my back, Doctor!” (episode 1): values and clinical decision-making

Summary

Topics covered in this chapter

Three key points about values in medicine are outlined as illustrated by a GP consultation for chronic low back pain between Dr. Gulati and her patient, Roy Walker.

Other topics include:

Ethical and other values

Clinician and patient values

Foreground and background values

The network of values

Values, decisions and actions

NICE guidelines for low back pain.

Take-away message for practice

Values in medicine (i) include but are wider than ethics, (ii) are everywhere and (iii) are action-guiding.

Values-based practice, as we indicated in our introduction, is a new skills-based approach to working more effectively with complex and sometimes conflicting values in medicine. As such, values-based practice is like evidence-based practice: both are responses to the growing complexity of clinical decision-making. Evidence-based practice supports clinical decision-making where complex and sometimes conflicting evidence is in play. Values-based practice supports clinical decision-making where complex and sometimes conflicting values are in play.

In this chapter, we illustrate the complexities of values in medicine not with a high-profile “ethics case” but rather as they emerge from the everyday scenario of a GP consultation for chronic low back pain. Three key points will emerge from this scenario, namely that values in medicine:

are wider than just ethics, which nonetheless are an important aspect of our values;

are everywhere in medicine, although not always recognized for what they are;

are important because they stand alongside evidence in guiding decisions and actions.

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