Whose decision is it? The microstructure of medical decision making.
Medical decision making is sometimes viewed as a relatively simple process in which a decision may be made by the patient, by the physician, or by both patient and physician working together. This two-dimensional portrayal eclipses the important role that others, such as other professionals, family, and friends, may play in the process; as an example of this phenomenon, we trace the evolution of a decision of a teenager with cancer who is contemplating discontinuing chemotherapy. This example also shows how a decision can usefully be understood as consisting of a number of identifiable substeps--what we call the "microstructure" of the decision. These steps show how the physician can play an important role without usurping the patient's rightful decisional authority.
Whitney
Simon N
SN
Department of Family and Community Medicine, Houston Center for Education and Research on Therapeutics, Baylor College of Medicine, 3701 Kirby Drive, Suite 600, Houston, TX 77098, USA. swhitney@bcm.edu
D002755:Choice Behavior / Q000941:ethics; D003657:Decision Making / Q000941:ethics*; D006801:Humans; D010348:Patient Care Team; D010358:Patient Participation; D010817:Physician-Patient Relations / Q000941:ethics*; D011368:Professional-Family Relations / Q000941:ethics