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  1. Article ; Online: Clinical judgement in precision medicine.

    Tonelli, Mark R

    Journal of evaluation in clinical practice

    2018  Volume 24, Issue 3, Page(s) 646–648

    Abstract: Precision medicine, which aims to individualize care based upon the unique combination of genetic, environmental, and lifestyle features in particular patients, will require an evolution in clinical decision making. Practitioners of precision medicine ... ...

    Abstract Precision medicine, which aims to individualize care based upon the unique combination of genetic, environmental, and lifestyle features in particular patients, will require an evolution in clinical decision making. Practitioners of precision medicine will need to utilize an expanded body of medical knowledge derived from a wide variety of sources. Clinical judgement in the case-based reasoning necessary for individualizing care will involve understanding and utilizing methodological approaches not commonly invoked in medicine, including mechanistic and qualitative research results. Instead of searching for an answer in the published literature, precision medicine demands clinical judgement that finds the reasons for clinical decisions within, not without, the patient.
    MeSH term(s) Clinical Decision-Making ; Judgment ; Knowledge ; Philosophy, Medical ; Precision Medicine
    Language English
    Publishing date 2018-02-21
    Publishing country England
    Document type Journal Article
    ZDB-ID 1327355-3
    ISSN 1365-2753 ; 1356-1294
    ISSN (online) 1365-2753
    ISSN 1356-1294
    DOI 10.1111/jep.12892
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  2. Article ; Online: Supporting Real-Time Ethical Deliberation in Contingency Capacity During the COVID-19 Pandemic.

    Butler, Catherine R / Tonelli, Mark R

    The American journal of bioethics : AJOB

    2021  Volume 21, Issue 8, Page(s) 25–27

    MeSH term(s) COVID-19 ; Humans ; Morals ; Pandemics ; SARS-CoV-2
    Language English
    Publishing date 2021-07-23
    Publishing country United States
    Document type Journal Article ; Comment
    ZDB-ID 2060433-6
    ISSN 1536-0075 ; 1526-5161
    ISSN (online) 1536-0075
    ISSN 1526-5161
    DOI 10.1080/15265161.2021.1940359
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  3. Article ; Online: Experiential knowledge in clinical medicine: use and justification.

    Tonelli, Mark R / Shapiro, Devora

    Theoretical medicine and bioethics

    2020  Volume 41, Issue 2-3, Page(s) 67–82

    Abstract: Within the evidence-based medicine (EBM) construct, clinical expertise is acknowledged to be both derived from primary experience and necessary for optimal medical practice. Primary experience in medical practice, however, remains undervalued. Clinicians' ...

    Abstract Within the evidence-based medicine (EBM) construct, clinical expertise is acknowledged to be both derived from primary experience and necessary for optimal medical practice. Primary experience in medical practice, however, remains undervalued. Clinicians' primary experience tends to be dismissed by EBM as unsystematic or anecdotal, a source of bias rather than knowledge, never serving as the "best" evidence to support a clinical decision. The position that clinical expertise is necessary but that primary experience is untrustworthy in clinical decision-making is epistemically incoherent. Here we argue for the value and utility of knowledge gained from primary experience for the practice of medicine. Primary experience provides knowledge necessary to diagnose, treat, and assess response in individual patients. Hierarchies of evidence, when advanced as guides for clinical decisions, mistake the relationship between propositional and experiential knowledge. We argue that primary experience represents a kind of medical knowledge distinct from the propositional knowledge produced by clinical research, both of which are crucial to determining the best diagnosis and course of action for particular patients.
    MeSH term(s) Clinical Competence/standards ; Humans ; Knowledge ; Problem-Based Learning/methods ; Problem-Based Learning/standards
    Language English
    Publishing date 2020-04-21
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 1418481-3
    ISSN 1573-0980 ; 1573-1200 ; 1386-7415
    ISSN (online) 1573-0980 ; 1573-1200
    ISSN 1386-7415
    DOI 10.1007/s11017-020-09521-0
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  4. Article ; Online: Teaching Medical Epistemology within an Evidence-Based Medicine Curriculum.

    Tonelli, Mark R / Bluhm, Robyn

    Teaching and learning in medicine

    2020  Volume 33, Issue 1, Page(s) 98–105

    Abstract: Issue: ...

    Abstract Issue:
    MeSH term(s) Clinical Competence/standards ; Clinical Medicine/education ; Competency-Based Education/organization & administration ; Curriculum ; Education, Medical, Undergraduate/organization & administration ; Evidence-Based Medicine/organization & administration ; Humans ; Philosophy, Medical ; Students, Medical/statistics & numerical data
    Language English
    Publishing date 2020-12-23
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1038640-3
    ISSN 1532-8015 ; 1040-1334
    ISSN (online) 1532-8015
    ISSN 1040-1334
    DOI 10.1080/10401334.2020.1835666
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  5. Article ; Online: Lessons, intended and learned, from satire.

    Tonelli, Mark R

    Journal of evaluation in clinical practice

    2016  Volume 22, Issue 1, Page(s) 141–142

    MeSH term(s) Evidence-Based Medicine ; Learning ; Mother-Child Relations ; Randomized Controlled Trials as Topic ; Research Design ; Wit and Humor as Topic ; Wounds and Injuries/therapy
    Language English
    Publishing date 2016-02
    Publishing country England
    Document type Letter
    ZDB-ID 1327355-3
    ISSN 1365-2753 ; 1356-1294
    ISSN (online) 1365-2753
    ISSN 1356-1294
    DOI 10.1111/jep.12527
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  6. Article ; Online: Person-centred shared decision making.

    Tonelli, Mark R / Sullivan, Mark D

    Journal of evaluation in clinical practice

    2019  Volume 25, Issue 6, Page(s) 1057–1062

    Abstract: While multiple versions of shared decision making (SDM) have been advanced, most share two seemingly essential elements: (a) SDM is primarily focused on treatment choices and (b) the clinician is primarily responsible for providing options while the ... ...

    Abstract While multiple versions of shared decision making (SDM) have been advanced, most share two seemingly essential elements: (a) SDM is primarily focused on treatment choices and (b) the clinician is primarily responsible for providing options while the patient contributes values and preferences. We argue that these two elements render SDM suboptimal for clinical practice. We suggest that SDM is better viewed as collaboration in all aspects of clinical care, with clinicians needing to fully engage with the patient's experience of illness and participation in treatment. SDM can only take place within an ongoing partnership between clinician and patient, both respecting the other as a person, not as part of an isolated encounter. Respect for the patient as a person goes beyond respect for their choice. Non-interference is not the only way, or even the most important way, to respect patient autonomy. Knowing the patient as a person and providing an autonomy-supportive context for care are crucial. That is, the clinician must know the patient well enough to be able to answer the patient's question "What would you do, if you were me?" This approach acknowledges clinicians as persons, requiring them to understand patients as persons. We provide examples of such a model of SDM and assert that this pragmatic method does not require excessive time or effort on the part of clinicians or patients but does require direct and particular knowledge of the patient that is often omitted from clinical decisions.
    MeSH term(s) Cooperative Behavior ; Decision Making, Shared ; Humans ; Informed Consent ; Patient Participation/methods ; Patient Participation/psychology ; Patient Preference ; Patient-Centered Care/methods ; Personhood ; Physicians/psychology
    Language English
    Publishing date 2019-08-12
    Publishing country England
    Document type Journal Article
    ZDB-ID 1327355-3
    ISSN 1365-2753 ; 1356-1294
    ISSN (online) 1365-2753
    ISSN 1356-1294
    DOI 10.1111/jep.13260
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  7. Article ; Online: Mechanisms in clinical practice: use and justification.

    Tonelli, Mark R / Williamson, Jon

    Medicine, health care, and philosophy

    2019  Volume 23, Issue 1, Page(s) 115–124

    Abstract: While the importance of mechanisms in determining causality in medicine is currently the subject of active debate, the role of mechanistic reasoning in clinical practice has received far less attention. In this paper we look at this question in the ... ...

    Abstract While the importance of mechanisms in determining causality in medicine is currently the subject of active debate, the role of mechanistic reasoning in clinical practice has received far less attention. In this paper we look at this question in the context of the treatment of a particular individual, and argue that evidence of mechanisms is indeed key to various aspects of clinical practice, including assessing population-level research reports, diagnostic as well as therapeutic decision making, and the assessment of treatment effects. We use the pulmonary condition bronchiectasis as a source of examples of the importance of mechanistic reasoning to clinical practice.
    MeSH term(s) Bronchiectasis/physiopathology ; Bronchiectasis/therapy ; Clinical Decision-Making/methods ; Evidence-Based Medicine/methods ; Humans
    Language English
    Publishing date 2019-07-17
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 1440052-2
    ISSN 1572-8633 ; 1386-7423
    ISSN (online) 1572-8633
    ISSN 1386-7423
    DOI 10.1007/s11019-019-09915-5
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  8. Article ; Online: Understanding the similarities and distinctions between withholding and withdrawing life-sustaining interventions.

    Tonelli, Mark R / Curtis, J Randall

    Minerva anestesiologica

    2018  Volume 84, Issue 6, Page(s) 664–666

    MeSH term(s) Humans ; Intensive Care Units ; Life Support Care
    Language English
    Publishing date 2018-03-27
    Publishing country Italy
    Document type Editorial ; Comment
    ZDB-ID 123584-9
    ISSN 1827-1596 ; 0026-4717 ; 0375-9393
    ISSN (online) 1827-1596
    ISSN 0026-4717 ; 0375-9393
    DOI 10.23736/S0375-9393.18.12829-X
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  9. Article ; Online: Knowledge for Precision Medicine: Mechanistic Reasoning and Methodological Pluralism.

    Tonelli, Mark R / Shirts, Brian H

    JAMA

    2017  Volume 318, Issue 17, Page(s) 1649–1650

    Language English
    Publishing date 2017--07
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
    ZDB-ID 2958-0
    ISSN 1538-3598 ; 0254-9077 ; 0002-9955 ; 0098-7484
    ISSN (online) 1538-3598
    ISSN 0254-9077 ; 0002-9955 ; 0098-7484
    DOI 10.1001/jama.2017.11914
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  10. Article ; Online: Palliative Care in the ICU and the Role for Physician-Assisted Dying-Or Lack Thereof.

    Curtis, J Randall / Tonelli, Mark R

    Critical care medicine

    2017  Volume 45, Issue 2, Page(s) 356–357

    MeSH term(s) Euthanasia ; Humans ; Intensive Care Units ; Palliative Care ; Suicide, Assisted ; Terminal Care
    Language English
    Publishing date 2017-01-17
    Publishing country United States
    Document type Editorial ; Research Support, Non-U.S. Gov't ; Comment
    ZDB-ID 197890-1
    ISSN 1530-0293 ; 0090-3493
    ISSN (online) 1530-0293
    ISSN 0090-3493
    DOI 10.1097/CCM.0000000000001947
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