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9 - Hierarchical and Complex Pharmacotherapy Decision-Making

Published online by Cambridge University Press:  25 March 2024

Joseph F. Goldberg
Affiliation:
Icahn School of Medicine at Mount Sinai, New York
Stephen M. Stahl
Affiliation:
University of California San Diego
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Summary

In preceding chapters, we have focused mainly on how to think through clinical problems that are often ambiguous or have multiple viable solutions, each with their respective pros and cons. We have deliberately refrained from offering specific recommendations about “what to do” in a given situation when no single best answer may exist. When that happens, the clinician’s task involves framing testable hypotheses and applying a reasoning process to arrive at a sensible individualized treatment regimen (ITR) for a given patient based on their unique clinical profile. Our goal has been to steer readers away from one-size-fit-all protocol-driven care and replace that approach with a more decision-analytic patient-specific iterative strategy, where nodes along a decision tree are determined by the personalized characteristics of a given individual.

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