title: Distributed decision making: the anatomy of decisions-in-action.
abstract: Conceptualising the doctor-patient relationship has been a central project for both medicine and medical sociology. This paper seeks to show how an understanding of the distributed nature of medical practice can help us research the decision-making process in doctor-patient encounters. I draw on a range of empirical studies of medical interaction, knowledge, technology and work in primary and secondary care. I describe the 'ethno-methods' (Garfinkel 1967) of patient-orientated medical decision making in order to highlight some of the fundamental facets of distributed decision making. Initially, I outline how decision making is an ongoing event that often evolves over multiple encounters. I then show how decision making is never just a solo, cognitive activity but rather distributed over a range of people. Finally, I outline how decision making is initiated, sustained and transformed over a range of encounters with both people and technologies. I argue that recognising the distributed nature of decision making shifts the focus from overly prescriptive visions of decision making to more plausible, albeit, more mundane sets of ideals. Centrally, a focus on distribution offers new opportunities actively to engage with, support and research decision-making-in-action.
authors.affiliation: Institute of Health and Society, Newcastle University, UK. tim.rapley@newcastle.ac.uk
authors.forename: Tim
authors.initials: T
authors.lastname: Rapley
mesh_terms: D003657:Decision Making; D005260:Female; D017144:Focus Groups; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D010358:Patient Participation; D010817:Physician-Patient Relations; D013222:State Medicine; D006113:United Kingdom