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How are patient characteristics relevant for physicians' clinical decision making in diabetes? An analysis of qualitative results from a cross-national factorial experiment

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  • Lutfey, Karen E.
  • Campbell, Stephen M.
  • Renfrew, Megan R.
  • Marceau, Lisa D.
  • Roland, Martin
  • McKinlay, John B.

Abstract

Variations in medical practice have been widely documented and are a linchpin in explanations of health disparities. Evidence shows that clinical decision making varies according to patient, provider and health system characteristics. However, less is known about the processes underlying these aggregate associations and how physicians interpret various patient attributes. Verbal protocol analysis (otherwise known as 'think-aloud') techniques were used to analyze open-ended data from 244 physicians to examine which patient characteristics physicians identify as relevant for their decision making. Data are from a vignette-based factorial experiment measuring the effects of: (a) patient attributes (age, gender, race and socioeconomic status); (b) physician characteristics (gender and years of clinical experience); and (c) features of the healthcare system in two countries (USA, United Kingdom) on clinical decision making for diabetes. We find that physicians used patients' demographic characteristics only as a starting point in their assessments, and proceeded to make detailed assessments about cognitive ability, motivation, social support and other factors they consider predictive of adherence with medical recommendations and therefore relevant to treatment decisions. These non-medical characteristics of patients were mentioned with much greater consistency than traditional biophysiologic markers of risk such as race, gender, and age. Types of explanations identified varied somewhat according to patient characteristics and to the country in which the interview took place. Results show that basic demographic characteristics are inadequate to the task of capturing information physicians draw from doctor-patient encounters, and that in order to fully understand differential clinical decision making there is a need to move beyond documentation of aggregate associations and further explore the mental and social processes at work.

Suggested Citation

  • Lutfey, Karen E. & Campbell, Stephen M. & Renfrew, Megan R. & Marceau, Lisa D. & Roland, Martin & McKinlay, John B., 2008. "How are patient characteristics relevant for physicians' clinical decision making in diabetes? An analysis of qualitative results from a cross-national factorial experiment," Social Science & Medicine, Elsevier, vol. 67(9), pages 1391-1399, November.
    • Handle: RePEc:eee:socmed:v:67:y:2008:i:9:p:1391-1399
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    References listed on IDEAS

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    1. Scott, Anthony & Shiell, Alan & King, Madeleine, 1996. "Is general practitioner decision making associated with patient socio-economic status?," Social Science & Medicine, Elsevier, vol. 42(1), pages 35-46, January.
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    1. Luca Fumarco & Benjamin Harrell & Patrick Button & David Schwegman & E Dils, 2020. "Gender Identity, Race, and Ethnicity-based Discrimination in Access to Mental Health Care: Evidence from an Audit Correspondence Field Experiment," NBER Working Papers 28164, National Bureau of Economic Research, Inc.
    2. Alex Stallman & Nicola Sheeran & Mark Boschen, 2023. "A Qualitative Exploration of General Practitioners’ Treatment Decision-Making for Depressive Symptoms," Medical Decision Making, , vol. 43(4), pages 498-507, May.
    3. Puckett, Cassidy & Wong, Jenise C. & Daley, Tanicia C. & Cossen, Kristina, 2020. "How organizations shape medical technology allocation: Insulin pumps and pediatric patients with type 1 diabetes," Social Science & Medicine, Elsevier, vol. 249(C).
    4. Elstad, Emily A. & Lutfey, Karen E. & Marceau, Lisa D. & Campbell, Stephen M. & von dem Knesebeck, Olaf & McKinlay, John B., 2010. "What do physicians gain (and lose) with experience? Qualitative results from a cross-national study of diabetes," Social Science & Medicine, Elsevier, vol. 70(11), pages 1728-1736, June.
    5. Lay-Yee, Roy & Scott, Alastair & Davis, Peter, 2013. "Patterns of family doctor decision making in practice context. What are the implications for medical practice variation and social disparities?," Social Science & Medicine, Elsevier, vol. 76(C), pages 47-56.
    6. Gage-Bouchard, Elizabeth A., 2017. "Social support, flexible resources, and health care navigation," Social Science & Medicine, Elsevier, vol. 190(C), pages 111-118.

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