Clinical reasoning in pandemic times

In pandemic times, the sudden and increasing demand for care in emergency care units, urgency and emergency can compromise the most precious delivery of value to the patient and the system: the structure of clinical reasoning.

Even in the face of this scenario, clinical decision making still needs to be based on the bioethical principles of beneficence, non-maleficence, autonomy, justice and equity.

Protectionist public policies in the economy to the detriment of the population may be leading patients to arrive late for care. It is necessary to define clear criteria for prioritizing calls by risk profile. There is no single approach based solely on symptoms. It is necessary to address the strategy for patients with COVID-19 and not only for COVID-19 disease.

The fear of making mistakes and becoming infected has led frontline professionals to identify all patients as victims of COVID-19. This is undoubtedly a premise. But it can’t be enough.

Within the logic of clinical reasoning, we must always maintain the sequence of more assertive and complete mental models, which quickly seek to obtain Subjective (anamnesis), Objective (Physical Examination), Analysis (Diagnostic Hypothesis, Associated Diagnostics and Diagnosis) information Differential) and Plan (Strategies for the Diagnostic and Therapeutic approach).

Within this context, the roles and responsibilities of the entire frontline team – screening, risk classification and medical care – need to be very well defined, so that decision making is agile, without rework, without waste and that care can be effectively coordinated, integrated and patient-centered. Communication is key. Registration, essential.

We know that the pressure is great, and time is short, but every professional on the front line must always keep the following questions in mind: Could it not be COVID-19? Could there be any other comorbidity being decompensated by COVID-19? Which supporting factors may be contributing to the current stage of the disease’s evolution?

This attitude can save many lives.

Infection Control and Biosafety
Precautions in blood donation and transfusion-COVID-19 context

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