Tracing the decision-making process of physicians with a Decision Process Matrix

BMC Medical Informatics and Decision Making

Research Article

Cristina Zulian¹  Daniel Hausmann¹  Edouard Battegay²  Lukas Zimmerli² 

[1] Department of Psychology, Applied Social and Health Psychology, University of Zurich, Box 14, Binzmuehlestrasse 14, 8050, Zurich, Switzerland;Division of Internal Medicine, University Hospital Zurich, Zurich, Switzerland;

关键词: Medical decision-making;    Decision process matrix;    Information search;    Confidence;   

DOI  :  10.1186/s12911-016-0369-1

 received in 2015-08-27, accepted in 2016-10-04,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundDecision-making processes in a medical setting are complex, dynamic and under time pressure, often with serious consequences for a patient’s condition.ObjectiveThe principal aim of the present study was to trace and map the individual diagnostic process of real medical cases using a Decision Process Matrix [DPM]).MethodsThe naturalistic decision-making process of 11 residents and a total of 55 medical cases were recorded in an emergency department, and a DPM was drawn up according to a semi-structured technique following four steps: 1) observing and recording relevant information throughout the entire diagnostic process, 2) assessing options in terms of suspected diagnoses, 3) drawing up an initial version of the DPM, and 4) verifying the DPM, while adding the confidence ratings.ResultsThe DPM comprised an average of 3.2 suspected diagnoses and 7.9 information units (cues). The following three-phase pattern could be observed: option generation, option verification, and final diagnosis determination. Residents strove for the highest possible level of confidence before making the final diagnoses (in two-thirds of the medical cases with a rating of practically certain) or excluding suspected diagnoses (with practically impossible in half of the cases).DiscussionThe following challenges have to be addressed in the future: real-time capturing of emerging suspected diagnoses in the memory of the physician, definition of meaningful information units, and a more contemporary measurement of confidence.ConclusionsDPM is a useful tool for tracing real and individual diagnostic processes. The methodological approach with DPM allows further investigations into the underlying cognitive diagnostic processes on a theoretical level and improvement of individual clinical reasoning skills in practice.

【 授权许可】

CC BY   
© The Author(s). 2016