This project took a unique perspective on the investigation of decision making in healthcare by examining clinician-patient consultation using methods from linguistics and communication. Our goal was to identify cognitive and behavioral patterns in interactions of clinicians-in-trainings with patients that correspond to decision making processes in time constrained situations. Objective measures of clinician-patient communications in both naturalistic and simulated settings is a promising way to examine clinician decision making under uncertainty and time pressure, and to identify specific errors in decision making that may lead to misdiagnoses. We sought to detect distinguishable patterns of communication adopted by clinicians-in-training in clinical consultation settings under time pressure. A pilot study reported in this paper provides objective measurement tools to study miscommunication within clinician-patient consultations and may positively influence the treatments and services offered within patient consultations.
Get full access to this article
View all access options for this article.
References
1.
BrickleyL.S.HoekelmanR.A. (1999). Bates' guide to physical examination and history taking (7th ed.). Philadelphia, PA: Lippincot-Raven Publishers.
2.
CarayonP.WoodK. E. (2009). Patient safety. Information, Knowledge, Systems Management, 8(1), 23-46.
3.
CroskerryP. (2003). Cognitive forcing strategies in clinical decisionmaking.Annals of Emergency Medicine, 41, 110-120. DOI:10.1067/mem.2003.22
4.
CroskerryP. (2009). A universal model of diagnostic reasoning.Academic Medicine, 84(8), 1022-1028.
5.
EdwardsW. (1954). The theory of decision making. Psychological Bulletin, 51, 380-417.
6.
EpsteinR. M.HadeeTCarrollJ. (2007). “Could this be something serious?” Reassurance, uncertainty, and empathy in response to patients' expressions of worry.Journal of General Internal Medicine, 22(12), 1731-1739.
7.
GraberM. L.FranklinN.GordonR. (2005). Diagnostic error in internal medicine.Archives of Internal Medicine, 165(13), 1493.
8.
HallK. H. (2002). Reviewing intuitive decision-making and uncertainty: the implications for medical education. Medical Education, 36, 216-224.
9.
HarveyK.KoteykoN. (2012). Exploring health communication: Language in action. Abingdon: Routledge.
10.
HenrikssonA.VelupillaiS. (2010, July). Levels of certainty in knowledge-intensive corpora: An initial annotation study. In Proceedings of the Workshop on Negation and Speculation in Natural Language Processing (pp. 41-45).Association for Computational Linguistics.
11.
Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, D.C.: The National Academies Press.
12.
Institute of Medicine. (1999). To err is human: Building a safer health system. Washington, D.C.: The National Academies Press.
13.
KahnemanD. (2003). A perspective on judgment and choice: Mapping bounded rationality. American Psychologist, 58(9), 697-720.
14.
KahnemanD. (2011). Thinking, fast and slow. New York, NY: Farrar, Straus and Giroux.
15.
KahnemanD.KleinG. (2009). Conditions for intuitive expertise: A failure to disagree. American Psychologist, 64(6), 515-526
16.
KahnemanD.TverskyA. (1972). Subjective probability: A judgment of representativeness. Cognitive Psychology, 3(3), 430-454.
17.
KahnemanD.TverskyA. (1979). Prospect theory: An analysis of decision under risk. Econometrika, 47(2), 263-292.
18.
KahnemanD.TverskyA. (1984). Choices, values, and frames.American Psychologist, 39(4), 341-350.
19.
KleinG. (1989). Recognition-primed decisions. Advances in Human-Machine Systems Research, Vol. 5 (pp. 47-92). JAI Press.
20.
KleinG. (1998). Sources of power: How people make decisions. Cambridge, MA: MIT Press.
21.
LipshitzR.KleinG.OrasanuJ.SalasE. (2001). Taking stock of naturalistic decision making. Journal of Behavioral Decision Making, 14(5), 331-352.
22.
LuceR. D.RaiffaH. (1957). Games and decisions. New York, NY: Wiley.
23.
MaukschL. BDugdaleD. C.DodsonS.EpsteinR. (2008). Relationship, communication, and efficiency in the medical encounter: Creating a clinical model from a literature review. Archives of Internal Medicine,168(13), 1387-1395.
24.
MoweryD.VelupillaiS.ChapmanW. W. (2012). Medical diagnosis lost in translation-Analysis of uncertainty and negation expressions in English and Swedish clinical texts. In BioNLP: Proceedings of the 2012 Workshop on Biomedical Natural Language Processing. Association for Computational Linguistics.
25.
NormanG. R.EvaE. W. (2010). Diagnostic error and clinical reasoning.Medical Education, 44, 94-100.
26.
ReasonJ. (1990).Human error. Cambridge: Cambridge University Press.
27.
SchiffG. D.KimS.AbramsR.CosbyK.LambertB.ElsteinA. S.HaslerS.KrosnjarN.OdwaznyR.WisniewskiM. F.McNuttR. A. (2005). Diagnosing diagnostic errors: lessons from a multi-institutional collaborative project. Advances in Patient Safety: From Research to Implementation, 2, 255-278.
28.
SheerV. C.ClineR. J. (1995). Testing a model of perceived information adequacy and uncertainty reduction in physician-patient interactions. Journal of Applied Communication Research, 23, 44-59.
29.
StolperE.VandeWielM.Van RoyenP.Van BokhovenM.Van der WeijdenT.DinantG. J. (2010). Gut feelings as a third track in general practitioners’ diagnostic reasoning. Journal of General Internal Medicine, 197-203.
30.
TausczikY. R.PennebakerJ. W. (2010). The psy- chological meaning of words: LIWC and comput- erized text analysis methods. Journal of Language and Social Psychology, 29(1), 24-54.
31.
TverskyA.KahnemanD. (1973). Availability: A heuristic for judging frequency and probability. Cognitive Psychology5(2), 207-232.
32.
WestR.TurnerL H. (2007).Introducing communication theory: Analysis and application (3rd ed.). The McGraw-Hill Company.
33.
WickensC. D.HollandsJ. (2000). Engineering psychology and human performance (3rd ed.). New Jersey: Prentice Hall.
34.
WomackK.McCoyW.AlmC. O.CalvelliC.PelzJ. B.ShiP.HaakeA. (2012).Disfluencies as extra-propositional indicators of cognitive processing.Extra-Propositional Aspects of Meaning in Computational Linguistics (ExProM 2012), 1, 1-9.
