Clinical Problem Solving: A Behavioral Analysis

Kassirer, Jerome P.; Gorry, G. Anthony

doi:10.1007/978-1-4612-5108-8_6

Cited by 54 publications

(66 citation statements)

References 12 publications

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“…44 Documented clinical examples of sequential biases include data showing that sequential observations did not improve the accuracy of prognosis in ICU death or survival -perhaps demonstrating simple primacy 45,46 -and physicians demonstrating configural primacy by ignoring or eliminating later, discrepant information. 34,37,47 Old practice habits that have not been modified in the light of new information also introduce error into clinical decision-making. 43 Other biases, apart from those initially described by Tversky and Kahneman, have been shown to occur in medical decision-making.…”

Section: Errors and Biases In Expert Intuitionmentioning

confidence: 99%

“…Discrepancies with more profound consequences, such as causing a complete revision of a hypothesis, may be investigated, but often with the purpose of minimising or eliminating their impact, by finding grounds to reject them or to demonstrate that they are not truly disconfirmatory. 47 A second information bias is illustrated by Arthur Conan Doyle in a conversation between Inspector Gregory and Sherlock Holmes;…”

Section: Errors and Biases In Expert Intuitionmentioning

confidence: 99%

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Reviewing intuitive decision-making and uncertainty: the implications for medical education

2002

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It is argued that although uncertainty can be reduced, it can never be completely eliminated from decision-making. Therefore most decision-making performed in medicine contains an irreducible intuitive element and is thus vulnerable to these biases and heuristics. Given that few medical curricula overtly address the process of medical decision-making, both medical students and physicians remain vulnerable to these effects on their own (and their patients') decision-making. Insight via education appears the major means in which to avoid distorting decision-making processes.

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Section: Errors and Biases In Expert Intuitionmentioning

confidence: 99%

Section: Errors and Biases In Expert Intuitionmentioning

confidence: 99%

Reviewing intuitive decision-making and uncertainty: the implications for medical education

2002

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“…One of the most in¯uential theories of clinical decisionmaking is the hypothetico-deductive one that originated in medicine (Elstein et al 1978, Kassirer & Gorry 1978, but has subsequently been applied to nursing (e.g. Padrick et al 1987, Jones 1988, Carnevali & Thomas 1993, Taylor 1997.…”

Section: Brief Overview Of Clinical Decision Making Approachesmentioning

confidence: 99%

Classifying clinical decision making: a unifying approach

Buckingham

Adams

2000

Journal of Advanced Nursing

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This is the first of two linked papers exploring decision making in nursing which integrate research evidence from different clinical and academic disciplines. Currently there are many decision-making theories, each with their own distinctive concepts and terminology, and there is a tendency for separate disciplines to view their own decision-making processes as unique. Identifying good nursing decisions and where improvements can be made is therefore problematic, and this can undermine clinical and organizational effectiveness, as well as nurses' professional status. Within the unifying framework of psychological classification, the overall aim of the two papers is to clarify and compare terms, concepts and processes identified in a diversity of decision-making theories, and to demonstrate their underlying similarities. It is argued that the range of explanations used across disciplines can usefully be re-conceptualized as classification behaviour. This paper explores problems arising from multiple theories of decision making being applied to separate clinical disciplines. Attention is given to detrimental effects on nursing practice within the context of multidisciplinary health-care organizations and the changing role of nurses. The different theories are outlined and difficulties in applying them to nursing decisions highlighted. An alternative approach based on a general model of classification is then presented in detail to introduce its terminology and the unifying framework for interpreting all types of decisions. The classification model is used to provide the context for relating alternative philosophical approaches and to define decision-making activities common to all clinical domains. This may benefit nurses by improving multidisciplinary collaboration and weakening clinical elitism.

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“…Physicians with more training or experience with certain conditions may be more efficient at clinical problem solving within their area of expertise. 8 They may have greater knowledge and better developed technical skills, which may translate into improved processes and outcomes. [9][10][11] Excessive and narrow subspecialization, however, may yield fragmented care and inefficient referrals to multiple or inappropriate specialists.…”

Section: Discussionmentioning

confidence: 99%

Physicians’ reports of focused expertise in clinical practice

2000

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Little is known about the prevalence of focused expertise (special areas of expertise within a clinical field) among physicians, yet such expertise may influence how care is delivered. We surveyed general internists, pediatricians, cardiologists, infectious disease specialists, and orthopedic surgeons to describe the prevalence of focused expertise and identify associated physician and practice characteristics. About one quarter of generalists and three quarters of specialists reported a focused expertise within their primary specialty. Hospital-based physicians more often reported such expertise, and physicians reimbursed by capitation less often reported expertise. Learning how focused expertise affects processes and outcomes of care will contribute to decisions about physician training and staffing of medical groups. T he rapid expansion of medical knowledge and technology has fueled the growth of medical specialization over recent decades. 1 Many physicians have specialized their practice beyond traditional disciplines. Cardiologists, for example, may concentrate in areas such as echocardiography, electrophysiology, or interventional cardiology. The expansion of specialty boards, including increasing opportunities for certification within the traditional specialties, has further encouraged this trend toward more specialized training. 2 Expertise within generalist fields has been described less well than within specialist disciplines. In 1994, the American College of Physicians Task Force on Physician Supply envisioned general internists of the future as both experts in the general care of adults and local authorities with more specialized expertise, either in traditional, organsystem-based subspecialties or in new areas of internal medicine such as women's health and geriatrics. 3 One academic medical center now offers a fourth year of internal medicine residency training to foster focused expertise in the practice of general internal medicine. 4 Similar trends are evident in pediatrics, with the emergence of fellowship training and certification in fields such as adolescent medicine and behavioral-developmental pediatrics. 5,6 Generalists with focused expertise may be particularly useful in managed care organizations or in geographic areas with fewer specialists. A group of primary care physicians, each with complementary expertise, might share knowledge and skills and thus require fewer consultations with specialists.In this study, we sought to understand the prevalence and distribution of self-reported expertise in generalist and specialist fields so that future studies can investigate its effect on processes and outcomes of care. We asked physicians in 5 specialties whether they have focused expertise within their primary specialty. We also examined physician and practice characteristics associated with reporting focused expertise.

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Clinical Problem Solving: A Behavioral Analysis

Cited by 54 publications

References 12 publications

Reviewing intuitive decision-making and uncertainty: the implications for medical education

Reviewing intuitive decision-making and uncertainty: the implications for medical education

Classifying clinical decision making: a unifying approach

Physicians’ reports of focused expertise in clinical practice

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