UNDERSTANDING DOCTORS' PERCEPTIONS OF GOOD CLINICAL DECISION MAKING: AN INTERVIEW STUDY

Purpose: The aim of this qualitative study was to explore doctors’ views and experiences of how to make clinical judgements and decisions effectively. In particular we wanted to understand what aspects make them label a judgement or decision as “good” or “poor”.

Method(s): Semi-structured interviews were conducted with 15 doctors who worked in a variety of clinical specialties and grades. Doctors were asked about their experiences of making easy and challenging decisions in their clinical work and occasions when they felt uncomfortable with an aspect of their clinical judgement. They were asked about what they had learned from these situations and how they might have informed their future practice thereafter. We analysed the interview transcripts using a thematic framework method.

Result(s): Doctors unanimously believed that the essence of a “good decision” was one that had been reasoned well i.e. the process. The decision outcome was a less important marker of decision quality. A good reasoning process included the following four attributes; gathering relevant data efficiently, involving patients in the interaction, critical reflection on type of thought process needed, and implementing safety strategies.

Conclusion(s): There is an increasing interest in how to define a good clinical decision among scholars, but the doctor’s perspective has been notably lacking. This study makes an important contribution to the clinical reasoning literature by focusing on the doctor’s conceptual definition of good (and poor) clinical decisions. We found their view to be in line with that of the scholars who argue that the good decision is one that is reasoned well. This definition presents practical problems for measuring a good reasoning process as there is no common understanding of 'good' and 'bad' thinking. A clear understanding is needed of what constitutes good clinical decision making in order to design effective educational interventions. We highlight that good clinical reasoning should be explicitly and routinely taught in medical curricula and discuss how doctors may be educated to think critically about their own reasoning processes.