Sociologic Influences on Decision-Making by Clinicians

Abstract

Recent articles on clinical decision-making have proposed sophisticated quantitative methods for improving the physician's clinical judgment. Actual clinical decisions, however, are influenced by interactions between the clinician, the patient, and the sociocultural milieu as well as by biomedical considerations. This paper explores these sociologic influences on the decision-making process. Four types of sociologic factors influence the clinician's judgment: the characteristics of the patient; the characteristics of the clinician; the clinician's interaction with his profession and the health care system; and the clinician's relationship with the patient. To illustrate sociologic influences on clinical decision-making, this paper presents observations from the literature of sociology, clinical psychology, psychiatry, and medicine. Further studies are needed to provide additional empirical information.

Race and Sex Differences in Management and Outcomes of Patients After ST‐Elevation and Non–ST‐Elevation Myocardial Infarct: Results From the NCDR

“…In NSTEMI management, providers take on a larger role as gatekeepers of care delivery; as provider preference, judgment, and recommendations bear more weight, care may be more susceptible to subconscious biases. 30,31 This contrasts with management of STEMI, which is highly protocol driven, from care delivered in the field by emergency medical services and provision of acute care such as early medications and primary PCI. Such standardization of care may minimize the potential impact of clinician or health care-system bias.…”

Effects of Patient Compliance, Parental Education and Race on Nephrologists' Recommendations for Kidney

“…How do these findings shed light on the tangle of biologic, social and economic factors that contribute to 'race-based barriers' to kidney transplantation? Education A number of authors have asserted that 'sociocultural' status, including educational attainment, influences medical decision making by health professionals (20,21). A patients' educational level may be known or subjectively assessed.…”

The decisions regarding ADHD management (DRAMa) study: uncertainties and complexities in assessment, diagnosis and treatment, from the clinician’s point of view

“…Given these costs, effective management of ADHD is a significant health policy goal (8); however this requires accurate, reliable and valid diagnosis of the condition and the use of appropriate and proven treatment options. When making decisions to diagnose or treat patients, the literature suggests that clinicians are influenced by both clinical and nonclinical factors such as the potential cost of treatment and the patient's social-economic status (9)(10)(11)(12).…”