Abstract
We wanted to investigate the relationship of medical and non-medical factors with the clinical decision-making of pediatricians. We hypothesize that the addition of relevant medical information (either alarming or reassuring) will influence the physician’s decision-making, but that the addition of non-medical information will also play a role. To investigate this, we designed an online questionnaire containing ten clinical case-based scenarios, of which five focused on medical factors and five on non-medical/context factors, each scored on a five-point Likert scale. In total, 113 pediatricians completed the online questionnaire. Both medical and non-medical/context factors were considered relevant to change the initial decision in most cases. Additional information of an alarming nature induces the physician to become more worried, whereas reassuring information decreases this worry. In some cases, with the medical factors, the gender and the age of the pediatrician does have some effect on the clinical decision-making. We conclude that medical decision-making is affected by multiple intrinsic and extrinsic factors that differ between physicians. Our data indicate that these non-medical factors must be considered when making a medical decision, as it is crucial to be aware that they have a substantial influence on that decision-making.
Highlights
Clinical reasoning and medical decision-making are two crucial skills of any physician.The groundwork for this decision-making usually lies in physicians’ training, where basic medical concepts which are often illustrated with real life clinical cases
To gather cross-sectional data, we developed an online questionnaire, which contained four demographic questions and 10 clinical case-based scenarios, of which five focused on medical factors and five on non-medical or context factors
We focused on pediatricians as they often face complicated cases given the inclusion of parents in the medical decision-making process for minors
Summary
Clinical reasoning and medical decision-making are two crucial skills of any physician.The groundwork for this decision-making usually lies in physicians’ training, where basic medical concepts which are often illustrated with real life clinical cases. Physicians acquire experience based on their exposure to numerous and diverse cases, combined with advice from fellow physicians. This experience is organized into clinical scripts (or illness scripts) [1], which are used to efficiently recognize a constellation of symptoms in a patient throughout their professional life. Based on this theory one could erroneously conclude that clinical reasoning is nothing more than the application of a neurophysiological decision algorithm. It is a far more complex activity in which analytical and non-analytical reasoning play a significant role [2,3]
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