Doctors as a knowledge and intelligence building group: pragmatic principles underlying decision-making processes

Carrió, Francesc Borrell; Estany, Anna; Platt, Frederic W.; MoralesHidalgo, Vicente

doi:10.1136/jech-2014-203868

Cited by 4 publications

(5 citation statements)

References 24 publications

(21 reference statements)

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“…In considering the biopsychosociotechnical context, the focus should be on gathering relevant information to support decision-making, not drawing up an exhaustive topography of all biopsychosociotechnical influences (which would rarely be possible, in any case (Francisco Borrell-Carrió et al, 2015 )). Hardwiring the biopsychosociotechnical model into practice through tools such as structured patient interviewing methods (Smith et al, 2013 ), shared decision-making tools (Gonzales & Riek, 2013 ), data models (Green & Klinkman, 2015 ; Ziegelstein, 2018 ), or program design tools (e.g., checklists, logic models, etc.…”

Section: A Practical Theorymentioning

confidence: 99%

The biopsychosociotechnical model: a systems-based framework for human-centered health improvement

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2022

Health Systems

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The biopsychosocial model is among the most influential frameworks for human-centered health improvement but has faced significant criticism– both conceptual and pragmatic. This paper extends and fundamentally re-structures the biopsychosocial model by combining it with sociotechnical systems theory. The resulting biopsychosociotechnical model addresses key critiques of the biopsychosocial model, providing a more “practical theory” for human-centered health improvement. It depicts the determinants of health as complex adaptive system of systems; includes the the artificial world (technology); and provides a roadmap for systems improvement by: differentiating between “health status” and “health and needs assessment”, [promoting problem framing]; explaining health as an emergent property of the biopsychosociotechnical context [imposing a systems orientation]; focusing on “interventions” vs. “treatments” to modify the biopsychosociotechnical determinants of health, [expanding the solution space]; calling for a participatory design process [supporting systems awareness and goal-orientation]; and including intervention management to support the full lifecycle of health improvement.

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Section: A Practical Theorymentioning

confidence: 99%

The biopsychosociotechnical model: a systems-based framework for human-centered health improvement

Card

2022

Health Systems

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“…17,21 Intuitive decision-making is rapid because physicians make use of standard approaches to treatment based on clinical experience, which has been described as 'illness scripts'. 22,23 Analytic decision-making takes up more time and can involve close consideration of quantitative measurements and the medical literature to reach decisions on the balance of harms and benefits of a particular treatment. 17,18,24 Many other factors can potentially influence decision-making style including physician attributes such as knowledge, experience, self-efficacy, uncertainty, communication style, acceptance of new technology, training received, openness to change as well as physician demographic characteristics.…”

Section: The Treatment Options In the Unitedmentioning

confidence: 99%

“…Depending on the circumstances, physicians will either make intuitive decisions based on their overall experience (Heuristic or System 1) or will take an analytic and effortful approach by carefully considering all available information (Rational or System 2) . Intuitive decision‐making is rapid because physicians make use of standard approaches to treatment based on clinical experience, which has been described as ‘illness scripts’ . Analytic decision‐making takes up more time and can involve close consideration of quantitative measurements and the medical literature to reach decisions on the balance of harms and benefits of a particular treatment …”

Section: Introductionmentioning

confidence: 99%

UK vs US physician decision‐making in the treatment of haemophilia

2019

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IntroductionPatient–physician shared decision‐making (SDM) has become increasingly seen as having a positive effect on management of chronic diseases. However, little is known of the factors that encourage SDM or how effective it may be at improving health outcomes or how cost‐effective it is.AimTo investigate the uses and applications of patient physician–SDM in the management of haemophilia and the influence of healthcare systems in the United States and the United Kingdom.MethodsThis was a qualitative study based on interviews with treatment experts in the United States and United Kingdom. A grounded theory approach was used to analyse the data from the transcribed interviews and themes that emerged as related to the decision influencers. Twelve physicians from each country were interviewed by the author.ResultsTreatment guidelines were viewed as having only limited applicability because of the lack of universal best options in haemophilia. The US physicians in the sample appeared to be more influenced by patient preferences than physicians in the UK, who instead tended to follow policies and standards of care more closely. Physicians in both countries commented that many of their patents had become highly knowledgeable of their bleeding disorder. US physicians were sometimes limited by insurance company policies but also reported that they were often successful in appealing insurance decisions.ConclusionThe research suggests that there are different influences on decision‐making between healthcare systems; patients and overarching healthcare systems play a major role in how physicians treat haemophilia.

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“…Heuristic decision making (System 1) is an approach that relies on experience . Physicians simplify information by forming standard approaches to treatment‐based clinical experience, which have been termed “illness scripts.” Rational decision making (DMR) (System 2) is the slower approach, one that requires effort and conscious analysis . Physicians may analyse different factors, such as the ratio of harm to benefits, especially when there is no clear or standard procedure given unique or complex patient circumstances .…”

Section: Introductionmentioning

confidence: 99%

Shared decision making: Does a physician's decision‐making style affect patient participation in treatment choices for primary immunodeficiency?

Lamb

Wang

Lyytinen

2019

Evaluation Clinical Practice

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Overall health care spending in the United States is equivalent to more than 15% of GDP, yet outcomes rank below the top 25 in most quality categories when compared with other Organization for Economic Cooperation and Development (OECD) countries. The majority of spending is consumed by small patient populations with chronic diseases. Experts believe increased patient‐physician shared decision making (SDM) should result in better overall longitudinal care but understanding the physician's role in facilitating SDM is limited. Structural equation modelling was applied to results of a 2016 questionnaire‐based survey of 330 US physicians who treat approximately 55% of primary immune deficiency requiring immune globulin therapy; it tested the relationship between slow/rational vs fast/intuitive decision‐making styles and SDM as mediated by patient‐centric care and moderated by physician's trust in the patient. The results showed a statistically significant relationship between slow/rational decision making and SDM. The results also suggest differences related to age, gender, education, and race but no differences related to trust.

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Doctors as a knowledge and intelligence building group: pragmatic principles underlying decision-making processes

Cited by 4 publications

References 24 publications

The biopsychosociotechnical model: a systems-based framework for human-centered health improvement

The biopsychosociotechnical model: a systems-based framework for human-centered health improvement

UK vs US physician decision‐making in the treatment of haemophilia

Shared decision making: Does a physician's decision‐making style affect patient participation in treatment choices for primary immunodeficiency?

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