Sabine Salloch1, Ina Otte2, Anke Reinacher-Schick3, Jochen Vollmann2. 1. Institute for Ethics and History of Medicine, University Medicine Greifswald, Greifswald, Germany. 2. Institute for Medical Ethics and History of Medicine, Ruhr-University Bochum, Bochum, Germany. 3. Department for Hematology, Oncology and Palliative Care, St Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.
Abstract
BACKGROUND: Physicians' clinical expertise forms an exclusive body of competences, which helps them to find the appropriate diagnostics and treatment for each individual patient. Empirical evidence, however, suggests that there is an inverse relationship between the number of years in practice and the quality of care provided by a physician. Knowledge and adherence to professional standards (such as clinical guidelines) are often used as indicators in previous research. METHODS: Semistructured interviews and the Q method were used for an explorative study on oncologists' views on the interplay between their own clinical expertise, intuition, and the external evidence incorporated in clinical guidelines. The interviews were audio recorded, transcribed ad verbatim, and analysed using qualitative content analysis. RESULTS: Data analysis shows the complex character of clinical expertise with respect to experience, professional development, and intuition. An irreplaceable role is attributed to personal and bodily experience during the providing of care for a patient. Professional experience becomes important, particularly in those situations that lie out of the focus of "guideline medicine." Intuition is regarded as having a strong emotional component and helps for deciding which therapeutic option the patient can deal with. CONCLUSIONS: Using measurable knowledge and adherence to standards as indicators does not account for the complexity of clinical expertise. Other factors, such as the importance of bodily experience and physicians' intuitive knowledge, must be considered, also with respect to the occurrence of treatment biases.
BACKGROUND: Physicians' clinical expertise forms an exclusive body of competences, which helps them to find the appropriate diagnostics and treatment for each individual patient. Empirical evidence, however, suggests that there is an inverse relationship between the number of years in practice and the quality of care provided by a physician. Knowledge and adherence to professional standards (such as clinical guidelines) are often used as indicators in previous research. METHODS: Semistructured interviews and the Q method were used for an explorative study on oncologists' views on the interplay between their own clinical expertise, intuition, and the external evidence incorporated in clinical guidelines. The interviews were audio recorded, transcribed ad verbatim, and analysed using qualitative content analysis. RESULTS: Data analysis shows the complex character of clinical expertise with respect to experience, professional development, and intuition. An irreplaceable role is attributed to personal and bodily experience during the providing of care for a patient. Professional experience becomes important, particularly in those situations that lie out of the focus of "guideline medicine." Intuition is regarded as having a strong emotional component and helps for deciding which therapeutic option the patient can deal with. CONCLUSIONS: Using measurable knowledge and adherence to standards as indicators does not account for the complexity of clinical expertise. Other factors, such as the importance of bodily experience and physicians' intuitive knowledge, must be considered, also with respect to the occurrence of treatment biases.
Authors: Sophie Rees; Christopher Bassford; Jeremy Dale; Zoe Fritz; Frances Griffiths; Helen Parsons; Gavin D Perkins; Anne Marie Slowther Journal: J Eval Clin Pract Date: 2019-05-17 Impact factor: 2.431
Authors: Angela Luna-Meza; Natalia Godoy-Casasbuenas; José Andrés Calvache; Eduardo Díaz-Amado; Fritz E Gempeler Rueda; Olga Morales; Fabian Leal; Carlos Gómez-Restrepo; Esther de Vries Journal: BMC Palliat Care Date: 2021-05-28 Impact factor: 3.234