This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Carol A. Mancuso, MD; David N. Rose, MD

Arch Intern Med. 1987;147(7):1281-1285.

Abstract
• We explored physician's cognitive processes when making therapeutic decisions in a complex situation in which more than one treatment option is acceptable. Eighteen internists were presented with three hypothetical cases of patients with coronary artery disease and were asked to explain their treatment decisions. Based on process tracing, we characterized their method of therapeutic decision making. We found that physicians use a three-stage process that we call focal composite analysis: (1) selection of a few facts (focal points) and evaluation of each fact individually with respect to treatment options; (2) reassessment of the value of the focal points with respect to each other and unification of the case; and (3) summation of the values of the focal points to make the final decision. Using this model, we predicted physicians' actual treatment decisions in 96% of the hypothetical cases. Further analysis revealed a wide variety of focal points chosen overall, with most physicians choosing different focal points in each case. Of a total of 32 focal points chosen in three cases, only two focal points were predictors of the physicians' actual treatment choices. We conclude that in the complex problem considered here physicians use a staged process of choosing and evaluating information to make therapeutic choices.

(Arch Intern Med 1987;147:1281-1285)

Author Affiliations
From the Departments of Community Medicine and Medicine, Mt Sinai School of Medicine, City University of New York. Dr Mancuso is now with the Department of Medicine, New York Hospital.

Footnotes
Accepted for publication May 7, 1987.

Reprint requests to Mt Sinai School of Medicine, 1 Gustave L. Levy P1, New York, NY 10029 (Dr Rose).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Factors that Influence Prescribing Decisions
Schumock et al.
The Annals of Pharmacotherapy 2004;38:557-562.
ABSTRACT | FULL TEXT  

Scope and nature of prescribing decisions made by general practitioners
Denig et al.
Qual Saf Health Care 2002;11:137-143.
ABSTRACT | FULL TEXT  

Differences in the Treatment of Myocardial Infarction in the United States and Canada: A Comparison of Two University Hospitals
Pilote et al.
Arch Intern Med 1994;154:1090-1096.
ABSTRACT  

Evaluation of Physician Decision Making With the Use of Prior Probabilities and a Decision-Analysis Model
Carter et al.
Arch Fam Med 1993;2:529-534.
ABSTRACT