2012 Prescott Lecture: The nonpharmacologic basis of therapeutics: To get to the next level in interprofessional patient care, pharmacists need to recognize the social and interpersonal aspects of medical decision making

The aim of this paper is to analyze the medical decision-making process in the admission of patients into a Liver Transplant Program in a hospital in Lisbon, Portugal. The relationships and main strategies established among the medical specializations involved in this process will be investigated. The theoretical basis was drawn from medical sociology, in particular, from the social constructivist approaches, which highlight the relation between medical power and knowledge in the construction of medical decision-making. I attempt to elucidate the processes of negotiation through which a medical decision is constructed. The research methodology included non-participant observation and semi-structured interviews with participants from the two medical specializations of interest: liver surgeons and hepatologists. The management of risk and uncertainty in relation to patients’ access to liver transplantation is discussed and the strategic alliances that are formed during medical decision-making in search of consensus are investigated. The research findings show that medical practices and knowledge do not converge linearly to produce a coherent network of actions with a view to decision-making. Instead, medical decision-making is constructed through complex processes of negotiation. The different natures and levels of uncertainty and indetermination that are inherent in the social world of medicine have a fundamental influence on medical decision-making.

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Teleconsultation – collaborative work and opportunities for learning across organizational boundaries

Journal of Telemedicine and Telecare ◽

10.1258/jtt.2008.007012 ◽

2008 ◽

Vol 14 (7) ◽

pp. 377-380 ◽

Cited By ~ 13

Author(s):

Line Lundvoll Nilsen ◽

Anne Moen

Keyword(s):

Decision Making ◽

Patient Care ◽

Information Exchange ◽

Medical Decision Making ◽

Collaborative Work ◽

Medical Decision ◽

Medical Problems ◽

Organizational Boundaries ◽

Opportunities For Learning ◽

Communicative Process

Over a period of five months we observed teleconsultations between general practitioners (GPs) in community care and specialists in hospitals in two Norwegian health regions (A and B). In total, 47 teleconsultations between GPs and specialists were recorded. In region A, teleconsultations were organized when needed to discuss specific medical problems. In region B, teleconsultations took place during the specialists' daily morning meeting. The teleconsultations lasted for 5–40 min. There were three categories of talk. In the first two there was information exchange for patient updates and practical organization of the service. The third category, consultation, was the communicative process in which the GP and the specialist engaged in collaborative work, primarily discussing medical problems related to decision-making in patient care. Regular use of teleconsultation opens access to different repertoires of knowledge and experience, and brings knowledge to the point of patient care and medical decision-making.

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Surrogate’s Personal Sense of Duty as a Crucial Element in Medical Decision Making

10.1093/med/9780197598573.003.0002 ◽

2021 ◽

pp. 7-26

Author(s):

Chris Feudtner ◽

Theodore E. Schall ◽

Douglas L. Hill

Keyword(s):

Decision Making ◽

Medical Decision Making ◽

Adult Child ◽

Decision Makers ◽

Medical Decision ◽

Single Event ◽

Medical Decisions ◽

The Social ◽

Surrogate Decision Makers ◽

Surrogate Decision

Surrogates who must make medical decisions for other people—most often, loved ones—face difficult challenges not acknowledged in current models of medical decision making. Furthermore, medical decisions are typically not a single event, but an ongoing event that evolves over time. This chapter presents a broader conceptualization of medical decision making, highlighting that (1) surrogate decision makers often face multiple problems, not a single clear problem; (2) the path to the decision maker’s desired goal is often unclear and often constrained by past decisions; (3) the social relationships between the surrogate and the patient (parent, adult child, spouse) influence the decision making as surrogates try to fulfill their role as a good parent, good son/daughter, or good spouse; and (4) surrogate decision makers often judge themselves negatively in ways that influence their decisions and the outcome. Clinicians who recognize these complex influences on surrogate decision making may be better able to support surrogates through this difficult process.

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Influence of response shift and disposition on patient-reported outcomes may lead to suboptimal medical decisions: a medical ethics perspective

BMC Medical Ethics ◽

10.1186/s12910-019-0397-3 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Iris D. Hartog ◽

Dick L. Willems ◽

Wilbert B. van den Hout ◽

Michael Scherer-Rath ◽

Tom H. Oreel ◽

...

Keyword(s):

Decision Making ◽

Patient Care ◽

Patient Reported Outcomes ◽

Medical Decision Making ◽

Response Shift ◽

Cost Effective ◽

Medical Decision ◽

Medical Decisions ◽

Patient Reports ◽

Patient Reported

Abstract Background Patient-reported outcomes (PROs) are frequently used for medical decision making, at the levels of both individual patient care and healthcare policy. Evidence increasingly shows that PROs may be influenced by patients’ response shifts (changes in interpretation) and dispositions (stable characteristics). Main text We identify how response shifts and dispositions may influence medical decisions on both the levels of individual patient care and health policy. We provide examples of these influences and analyse the consequences from the perspectives of ethical principles and theories of just distribution. Conclusion If influences of response shift and disposition on PROs and consequently medical decision making are not considered, patients may not receive optimal treatment and health insurance packages may include treatments that are not the most effective or cost-effective. We call on healthcare practitioners, researchers, policy makers, health insurers, and other stakeholders to critically reflect on why and how such patient reports are used.

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Emotions and Medical Decision-Making

Social Psychology Quarterly ◽

10.1177/0190272519876937 ◽

2020 ◽

Vol 83 (2) ◽

pp. 174-194

Author(s):

Amanda M. Gengler

Keyword(s):

Health Care ◽

Decision Making ◽

Medical Decision Making ◽

Medical Decision ◽

Decision Making Process ◽

Medical Decisions ◽

Interactive Process ◽

The Social ◽

Life Threatening ◽

Ethnographic Data

Sociologists have written surprisingly little about the role emotions play in medical decision-making, largely ceding this terrain to psychologists who conceptualize emotional influences on decision-making in primarily cognitive and individualistic terms. In this article, I use ethnographic data gathered from parents and physicians caring for children with life-threatening conditions to illustrate how emotions enter the medical decision-making process in fundamentally interactional ways. Because families and physicians alike often defined emotions as useful information to guide the decision-making process, both parties could leverage them in health care interactions by eliciting or demonstrating emotional investment, strategically deploying emotionally charged symbols, and using emotions as tiebreakers to help themselves and one another make choices in the midst of uncertainty. Constructing emotions as valuable in the decision-making process and effectively marshalling them in these ways offered a number of advantages. It could make decisions easier to arrive at, help people feel more confident in the decisions they made, and reduce interpersonal conflict. By connecting the dynamic role emotions can play in the interactive process through which medical decisions are made to the social advantages they can produce, I point to an underappreciated avenue through which inequalities in health care are perpetuated.

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