Eirik H Ofstad1, Jan C Frich2, Edvin Schei3, Richard M Frankel4, Pål Gulbrandsen5. 1. The Research Center, Akershus University Hospital, Lorenskog, Norway. Electronic address: eirikofstad@gmail.com. 2. Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway. 3. Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway. 4. Indiana University School of Medicine, VA HSR&D Center of Excellence, Roudebush VA Medical Center, Indianapolis, USA. 5. Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lorenskog, Norway; The Research Center, Akershus University Hospital, Lorenskog, Norway.
Abstract
OBJECTIVE: To identify and characterize physicians' statements that contained evidence of clinically relevant decisions in encounters with patients in different hospital settings. METHODS: Qualitative analysis of 50 videotaped encounters from wards, the emergency room (ER) and outpatient clinics in a department of internal medicine at a Norwegian university hospital. RESULTS: Clinical decisions could be grouped in a temporal order: decisions which had already been made, and were brought into the encounter by the physician (preformed decisions), decisions made in the present (here-and-now decisions), and decisions prescribing future actions given a certain course of events (conditional decisions). Preformed decisions were a hallmark in the ward and conditional decisions a main feature of ER encounters. CONCLUSION: Clinical decisions related to a patient-physician encounter spanned a time frame exceeding the duration of the encounter. While a distribution of decisions over time and space fosters sharing and dilution of responsibility between providers, it makes the decision making process hard to access for patients. PRACTICE IMPLICATIONS: In order to plan when and how to involve patients in decisions, physicians need increased awareness of when clinical decisions are made, who usually makes them, and who should make them.
OBJECTIVE: To identify and characterize physicians' statements that contained evidence of clinically relevant decisions in encounters with patients in different hospital settings. METHODS: Qualitative analysis of 50 videotaped encounters from wards, the emergency room (ER) and outpatient clinics in a department of internal medicine at a Norwegian university hospital. RESULTS: Clinical decisions could be grouped in a temporal order: decisions which had already been made, and were brought into the encounter by the physician (preformed decisions), decisions made in the present (here-and-now decisions), and decisions prescribing future actions given a certain course of events (conditional decisions). Preformed decisions were a hallmark in the ward and conditional decisions a main feature of ER encounters. CONCLUSION: Clinical decisions related to a patient-physician encounter spanned a time frame exceeding the duration of the encounter. While a distribution of decisions over time and space fosters sharing and dilution of responsibility between providers, it makes the decision making process hard to access for patients. PRACTICE IMPLICATIONS: In order to plan when and how to involve patients in decisions, physicians need increased awareness of when clinical decisions are made, who usually makes them, and who should make them.
Authors: Stephanie Rennke; Patrick Yuan; Brad Monash; Rebecca Blankenburg; Ian Chua; Stephanie Harman; Debbie S Sakai; Adeena Khan; Joan F Hilton; Lisa Shieh; Jason Satterfield Journal: J Hosp Med Date: 2017-10-18 Impact factor: 2.960
Authors: Eirik Hugaas Ofstad; Jan C Frich; Edvin Schei; Richard M Frankel; Jūratė Šaltytė Benth; Pål Gulbrandsen Journal: BMJ Open Date: 2018-01-05 Impact factor: 2.692