Making decisions in the mechanistic, probabilistic and scientific domains of medicine: a qualitative study of medical practitioners

Abstract

Rationale, aims and objectives: To find out how medical practitioners perceive the processes of decision-making in the context of the individual patient and to examine the importance of decision-making in the development and identity of medical practitioners throughout their clinical lives and to suggest how these perceptions might influence medical pedagogy.Method: A qualitative study of medical practitioners of varying ages and specialties, using loosely structured biographical interviews that were read to determine the different ways in which decisions were constructed and recalled and the impact these decisions were felt to have on both the decision-maker and others for whom the decision was salient.Results: Personal decisions about career choice were important because they shaped the life of the practitioner and made a significant impact on those around them. Professional decisions were made in the domains of the mechanistic and probabilistic scientific world of medicine and in the domain of human relationships, emotions and suffering. There was often a tension between the different domains and the context of the life-world often modified decisions that might logically have been determined by evidence-based medicine and its bio-knowledge.Conclusions: Decisions had a strong effect on the development of identity within the field of practice. Individuals came to see themselves as doctors who made certain kinds of decisions of immediate relevance to the individual patient. Teaching medical students and graduates how to apply evidence to their decisions and how to use formal computational decision aids may well have a useful place in pedagogy, but the impact of decision-making on the lives of doctors and their individual patients deserves at least equal emphasis.