[Treatment regulations and treatment limits: factors influencing clinical decision-making].
BACKGROUND
Providing or withholding of treatment is based on a variety of factors. We sought for criteria in clinical decision making and reviewed attitudes towards clinical intuition and the patient's will.


METHODS
503 physicians (25.6 % females; mean age 36.3) in 49 departments at nine hospitals of the universities Bochum and Magdeburg filled in a validated questionnaire.


RESULTS
The most important factors in the decision to carry out a therapy were "international standards" and "own experience". The decision to omit a therapy was mainly influenced by the "patient's wish". Physicians with a higher status judged their own experience higher than young physicians, who considered the experience of colleagues more important. "Severe accompanying illnesses" and "multimorbidity" were the most frequently named reasons to withdraw a therapy. Intuitive decision-making was rare, especially in young physicians, although these decisions were seldom risky and often successful.


CONCLUSIONS
A patient's will plays a prominent role in clinical decision making, especially in decisions to withdraw or to withhold treatment. Cost containment and research interest have been called less important, a remarkable response from research-based university hospitals. Also remarkable is the recognition and importance of clinical intuition in situations of complex or missing information. This important aspect is rarely discussed in the literature or in medical education. The widely voiced concern that priorities in clinical care are guided by scientific interest, financial or technical possibilities could not be confirmed.
Baberg
H T
HT
Abteilung für Kardiologie und Angiologie, Berufsgenossenschaftliche Kliniken Bergmannsheil, Klinikum der Ruhr-Universität Bochum. henning.baberg@ruhr-uni-bochum.de
Kielstein
R
R
de Zeeuw
J
J
Sass
H-M
HM
D000328:Adult; D000367:Age Factors; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003657:Decision Making; D005260:Female; D005858:Germany; D006785:Hospitals, University; D006801:Humans; D019545:Intuition; D008020:Life Support Care / Q000706:statistics & numerical data*; D008297:Male; D008505:Medical Staff, Hospital / Q000523:psychology*; D010358:Patient Participation; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires; D028761:Withholding Treatment