A method for study of dilemmas during health care consultations

Abstract

No scientific methods have been developed for study of the difficulties or dilemmas which physicians and nurses experience during day-to-day consultations. Such methods have relevance for designers of computer-based decision support systems, medical educators, and administrators. This paper describes the theoretical background and details of a method where a video-recording is reviewed for stimulated recall of the perceived difficulties that occur during doctor-patient consultations. A phenomenological analysis is performed of the video-review comments. The stated dilemmas are categorized, using Habermas's epistemological theory, into those involving medical knowledge, social knowledge and personal competence. In a study of 46 primary care consultations, 262 dilemmas were identified from 400 comments. The influence of the research arrangements on the practice setting, as perceived by physicians and patients, were small.

Key Words:

• System design
• Medical decision-making
• Doctor-patient relationship
• Practice research