Research article

Clinical decision-making: physicians' preferences and experiences

Elizabeth Murray¹ , Lance Pollack² , Martha White³ and Bernard Lo³

¹  Department of Primary Care and Population Sciences, Royal Free and University College Medical School at University College London, Archway Campus, Highgate Hill, London N19 5LW, UK

²  Health Survey Research Unit, Center for AIDS Prevention Studies, University of California, San Francisco, 74 New Montgomery, Suite 600, San Francisco, California 94105, USA

³  Program in Medical Ethics, University of California, San Francisco, 521 Parnassus Avenue, Suite C126, Box 0903, San Francisco, California 94143-0903, USA

author email corresponding author email

BMC Family Practice 2007, 8:10doi:10.1186/1471-2296-8-10

Published:	15 March 2007

Abstract

Background

Shared decision-making has been advocated; however there are relatively few studies on physician preferences for, and experiences of, different styles of clinical decision-making as most research has focused on patient preferences and experiences. The objectives of this study were to determine 1) physician preferences for different styles of clinical decision-making; 2) styles of clinical decision-making physicians perceive themselves as practicing; and 3) the congruence between preferred and perceived style. In addition we sought to determine physician perceptions of the availability of time in visits, and their role in encouraging patients to look for health information.

Methods

Cross-sectional survey of a nationally representative sample of U.S. physicians.

Results

1,050 (53% response rate) physicians responded to the survey. Of these, 780 (75%) preferred to share decision-making with their patients, 142 (14%) preferred paternalism, and 118 (11%) preferred consumerism. 87% of physicians perceived themselves as practicing their preferred style. Physicians who preferred their patients to play an active role in decision-making were more likely to report encouraging patients to look for information, and to report having enough time in visits.

Conclusion

Physicians tend to perceive themselves as practicing their preferred role in clinical decision-making. The direction of the association cannot be inferred from these data; however, we suggest that interventions aimed at promoting shared decision-making need to target physicians as well as patients.