Article

Evaluating physician performance at individualizing care: A pilot study tracking contextual errors in medical decision making

Department of Medicine, University of Illinois at Chicago, Chicago, Illinois 60612, USA.
Medical Decision Making (Impact Factor: 2.27). 09/2007; 27(6):726-34. DOI: 10.1177/0272989X07306113
Source: PubMed

ABSTRACT Clinical decision making requires 2 distinct cognitive skills: the ability to classify patients' conditions into diagnostic and management categories that permit the application of research evidence and the ability to individualize or-more specifically-to contextualize care for patients whose circumstances and needs require variation from the standard approach to care. The purpose of this study was to develop and test a methodology for measuring physicians' performance at contextualizing care and compare it to their performance at planning biomedically appropriate care.
First, the authors drafted 3 cases, each with 4 variations, 3 of which are embedded with biomedical and/or contextual information that is essential to planning care. Once the cases were validated as instruments for assessing physician performance, 54 internal medicine residents were then presented with opportunities to make these preidentified biomedical or contextual errors, and data were collected on information elicitation and error making.
The case validation process was successful in that, in the final iteration, the physicians who received the contextual variant of cases proposed an alternate plan of care to those who received the baseline variant 100% of the time. The subsequent piloting of these validated cases unmasked previously unmeasured differences in physician performance at contextualizing care. The findings, which reflect the performance characteristics of the study population, are presented.
This pilot study demonstrates a methodology for measuring physician performance at contextualizing care and illustrates the contribution of such information to an overall assessment of physician practice.

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    • "Clinical decision making requires two distinct cognitive skills: ability to classify patients' conditions into diagnostic and management categories and ability to individualize or-more precisely-contextualize the better care for each patient whose circumstances and needs require variation from the standard approach to care [6]. In order to offer appropriate treatment, it is necessary to have a previously correct diagnosis. "
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    • "In these complex situations, an " acquaintance with particulars often makes us wiser than the possession of abstract formulas, however deep " (James, 1902/1961, p. xvii). Eliciting data about these " particulars " requires an ability to adopt multiple perspectives and effective communication with patients and families (McWhinney, 1989); yet this communication often does not occur (Weiner et al., 2007). "
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