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Methods Inf Med 1990; 29(01): 23-29
DOI: 10.1055/s-0038-1634768
Knowledge-based systems
Schattauer GmbH

The GP’s Dilemmas: A Study of Knowledge Need and Use During Health Care Consultations

T. Timpka
1   Department of Computer and Information Science
2   Department of Community Medicine, Linköping University, Linkoping, Sweden
,
Elisabeth Arborelius
2   Department of Community Medicine, Linköping University, Linkoping, Sweden
› Author AffiliationsAnn-Charlotte Nilsson provided proficient assistance with the data collection. Johan van der Lei of the Dept of Medical Informatics, Erasmus University, Rotterdam, The Netherlands, gave valuable comments on drafts of this paper. This work was funded by the Swedish MDA-program, the Swedish Medical Research Council and the Swedish Delegation for Research in the Social Sciences.
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Publication History

Publication Date:
06 February 2018 (online)

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Abstract

For use in system development, a method based on both qualitative and quantitative data was employed to study the difficulties – the dilemmas – a general practitioner (GP) faces during daily consultac tions. Video recordings were used for stimulated recall of the consultation. From 46 consultations, 262 dilemmas were identified by the 12 GPs involved. Medical dilemmas were encountered during three out of four consultations. Dilemmas in the communication with the patient occurred during two consultations out of three, while dilemmas in the organizational environment and dilemmas challenging the GP’s personal competence occurred during one consultation out of three, respectively. A phenomenological analysis of the comments showed that few dilemmas were described as problems during “hypothetico-deductive reasoning”. In many cases the GP found it difficult to understand the situation as a whole. Based on these qualitative data, a model of the GP’s management of ill-structured complex dilemmas is discussed and proposed, to be taken into account in the development of decision support systems for outpatient practice.

Key-Words

Decision-Making - General Practice - Doctor – Patient Consultation - Video Recordings - Qualitative Analysis - Decision Support
 

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