Problem perception, technology and effectiveness in medical practice.
OBJECTIVE
Evidence-based medicine and clinical guidelines have been found difficult to implement in the clinical practice--mainly because lack of evidence quality and guidelines that, generally, do not account for variations in the medical cases. Variation in the medical cases enhances task uncertainty and uncertainty seems to be further enhanced through clinical guidelines. In this article, concept development is attempted, where task uncertainty is classified into a few medical problem-solving processes according to differences in medical technology and in the (initial) perception of the medical problem. Furthermore is argued the need for using different strategies in evaluating performance quality in medical health care depending on the variation in the degree of task uncertainty.


METHODS
Qualitative data about medical activities related to certain diseases are used to exemplify problem-solving processes representing different types of task uncertainty.


RESULTS
It is argued that the main characteristics of medical problem-solving processes vary according to differences in medical technology and perception of perceived medical problem. Four main medical problem-solving processes are defined and demonstrated through empirical examples.


CONCLUSIONS
What may be regarded as rational behaviour is different for each type of problem-solving processes. Consequently, the processes need different organizational settings and need to be evaluated according to different criteria. Furthermore, from a practical point of view, development and education related to problem perception would seem as important as development of medical technology.
Professor, Department of Health and Society, Kristianstad University, Kristianstad, Sweden.
Leif
L
Holmberg
D019317:Evidence-Based Medicine / Q000458:organization & administration / Q000592:standards; D006801:Humans; D019095:Point-of-Care Systems / Q000592:standards*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000458:organization & administration*; D011340:Problem Solving; D058996:Quality Improvement; D012938:Social Perception; D013548:Sweden; D035501:Uncertainty