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BMC Medical Informatics and Decision Making
Published in: BMC Medical Informatics and Decision Making 1/2016

Open Access 01-12-2016 | Research article

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

Authors: Daniel Hausmann, Cristina Zulian, Edouard Battegay, Lukas Zimmerli

Published in: BMC Medical Informatics and Decision Making | Issue 1/2016

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Abstract

Background

Decision-making processes in a medical setting are complex, dynamic and under time pressure, often with serious consequences for a patient’s condition.

Objective

The 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]).

Methods

The 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.

Results

The 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).

Discussion

The 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.

Conclusions

DPM 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.
Literature
1.
Bergus G. Diagnostic process, making a diagnosis. In: Kattan MW, editor. Encyclopedia of Medical Decision Making. Thousand Oaks: Sage Publications; 2009. p. 379–82.
2.
Gale J, Marsden P. Diagnostics: Process not Product. In: Sheldon M, Brooke J, Rector A, editors. Decision-making in General Practice. New-York: Stockton; 1985. p. 59–90.CrossRef
3.
Elstein AS, Schwartz A. Evidence base of clinical diagnosis: Clinical problem solving and diagnostic decision making: selective review of the cognitive literature. BMJ. 2002;324:729–32.CrossRefPubMedPubMedCentral
4.
Légaré F, Moher D, Elwyn G, LeBlanc A, Gravel K. Instruments to assess the perception of physicians in the decision-making process of specific clinical encounters: a systematic review. BMC Med Inform Dec Mak. 2007;7:30.CrossRef
5.
Elstein AS, Shulman LS, Sprafka SA. Medical problem solving. An analysis of clinical reasoning. Cambridge: Harvard University Press; 1978.CrossRef
6.
Norman G. Research in clinical reasoning: Past history and current trends. Med Educ. 2005;39:418–27.CrossRefPubMed
7.
Bergus G, Schwartz A. Problem solving. In: Kattan MW, editor. Encyclopedia of Medical Decision Making. Thousand Oaks: Sage Publications; 2009. p. 909–13.
8.
Baerheim A. The diagnostic process in general practice: has it a two-phase structure? BMC Fam Pract. 2001;18(3):243–5.CrossRef
9.
Betsch T, Funke J, Plessner H. Denken – Urteilen, Entscheiden, Problemlösen [Thinking – judgment, decision making, problem solving]. Heidelberg: Springer; 2011.CrossRef
10.
Moskowitz A, Kuipers B, Kassirer J. Dealing with uncertainty, risks, and tradeoffs in clinical decisions. Ann Intern Med. 1988;108:435–49.CrossRefPubMed
11.
Sklar DP, Hauswald M, Johnson DR. Medical problem solving and uncertainty in the emergency department. Ann Emerg Med. 1991;20:987–91.CrossRefPubMed
12.
Kostopoulou O. Uncertainty in Medical Decisions. In: Kattan MW, editor. Encyclopedia of Medical Decision Making. Thousand Oaks: Sage Publications; 2009. p. 1157–60.
13.
Lutfey KE, Link CL, Marceaau LD, Grant RW, Adams A, Arber S, et al. Diagnostic certainty as a source of medical practice variation in coronary heart disease: Results from a cross-national experiment of clinical decision making. Med Decis Making. 2009;29:606–18.CrossRefPubMedPubMedCentral
14.
Cosby K. The role of certainty, confidence, and critical thinking in the diagnostic process: Good luck or good thinking? Acad Emerg Med. 2011;18(2):212–4.CrossRefPubMed
15.
Busemeyer JR, Townsend JT. Decision Field Theory: A dynamic-cognitive approach to decision making in an uncertain environment. Psychol Rev. 1993;100(3):432–59.CrossRefPubMed
16.
Hausmann D, Läge D. Sequential evidence accumulation in decision making: The individual desired level of confidence can explain the extent of information search. Judgm Decis Mak. 2008;3(3):229–43.
17.
Pauker SG, Kassirer JP. The threshold approach to clinical decision making. N Engl J Med. 1980;302(20):1109–17.CrossRefPubMed
18.
Djulbegovic B, Elqayam S, Reljic T, Hozo I, Miladinovic B, Tsalatsanis A, et al. How do physicians decide to treat: an empirical evaluation of the threshold model. BMC Med Inform Dec Mak. 2014;14:47.CrossRef
19.
Zsambok CE, Klein G, editors. Naturalistic Decision Making. Mahwah: Lawrence Erlbaum Associates; 1997.
20.
Klein G. Sources of power: How people make decisions. Cambridge: MIT Press; 1988.
21.
Lipshitz R, Klein G, Orasanu J, Salas E. Taking stock of naturalistic decision making. J Behav Decis Mak. 2001;14(5):331–52.CrossRef
22.
23.
Franklin A, Liu Y, Li Z, Nguyen V, Johnson TR, Robinson D, et al. Opportunistic decision making and complexity in emergency care. J Biomed Inform. 2011;44:469–76.CrossRefPubMed
24.
Conen D. Vorwort von Prof. Dr. med. Dieter Conen [Preface]. In: Walker D, Betz P, editors. Jetzt kommt der Patient – das Notfall-Flusskonzept [The patient is coming now – The emergency flow concept]. Zürich: Selbstverlag Walker project ag; 2013. p. 11–3.
25.
Schulte-Mecklenbeck M, Kühberger A, Ranyard R, editors. A handbook of process tracing methods for decision research. New York: Taylor & Francis Psychology Press; 2011.
26.
Shafer GA. Mathematical theory of evidence. Princeton: Princeton University Press; 1976.
27.
Pugh S. Total design: Integrated methods for successful product engineering. Workingham: Addison-Wesley; 1991.
28.
Eisenführ F, Weber M. Rationales Entscheiden [Rational decision-making]. Berlin: Springer; 1994.CrossRef
29.
Dörsam P. Grundlagen der Entscheidungstheorie [Basic principles of decision theory]. Heidenau: PD-Verlag; 1996.
30.
Yang JB, Singh MG. An evidential reasoning approach for multiple attribute decision making with uncertainty. IEEE Trans Syst Man Cyber. 1994;24:1–18.CrossRef
31.
Stausberg J, Person M. A process model of diagnostic reasoning in medicine. Int J Med Inform. 1999;54:9–23.CrossRefPubMed
32.
Gigerenzer G, Todd PM, the ABC Research Group, editors. Simple heuristics that make us smart. New York: Oxford University Press; 1999.
33.
Tversky A. Elimination by aspects: A theory of choice. Psychol Rev. 1972;79:281–99.CrossRef
34.
Simon HA. A behavioral model of rational choice. Q J Econ. 1955;69:99–118.CrossRef
35.
Appelt KC, Milch KF, Handgraaf MJJ, Weber EU. The Decision Making Individual Differences Inventory and guidelines for the study of individual differences in judgment and decision-making research. Judgm Decis Mak. 2011;6(3):252–62.
36.
Epstein RM. Whole mind and shared mind in clinical decision-making. Patient Educ Couns. 2013;90:200–6.CrossRefPubMed
37.
38.
Glöckner A, Witteman C, editors. Foundations for tracing intuition. Challenges and methods. Hove: Psychology Press; 2010.
39.
Bocklisch F. The vagueness of verbal probability and frequency expressions. Int J Adv Comput Sci. 2011;1:52–7.
40.
Hoffrage U, Lindsey S, Hertwig R, Gigerenzer G. Communicating statistical information. Science. 2000;290:2261–2.CrossRefPubMed
41.
Hogarth RM. Educating intuition. Chicago: The University of Chicago Press; 2001.
Metadata
Title
Tracing the decision-making process of physicians with a Decision Process Matrix
Authors
Daniel Hausmann
Cristina Zulian
Edouard Battegay
Lukas Zimmerli
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Medical Informatics and Decision Making / Issue 1/2016
Electronic ISSN: 1472-6947
DOI
https://doi.org/10.1186/s12911-016-0369-1

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