Clinical decision-making in dermatology: the role of clinical and non clinical factors [abstract]

Clinical decision-making is a complex process. It involves interaction of various clinical and nonclinical factors. The literature regarding this subject in non-dermatological specialities is expanding.1 However, in dermatology little is known about this process.2 The aim of this study was to explore common management decisions made in dermatology outpatient clinics and the main influences on these decisions. The investigator (FMH) observed the consultations of patients at a university hospital dermatology outpatient clinic. Verbatim notes were taken of the conversations between the clinicians and the patients. Inferences were drawn regarding different management decisions taken during these consultations and the possible factors influencing these decisions. 217 consultations (consultants¼66.8%, specialist registrars¼25.8%, clinical lecturers¼4.1%, clinical nurse specialists¼3.2%) were observed. The mean duration of the consultations was 11 minutes (SD¼6.99) with a significant difference between the consultation times for different clinicians (Po0.0001). The most frequently made decisions included: carrying out laboratory investigations (28.6%), starting new topical treatment (22.1%), discharge to primary care (17.5%), renewal of systemic medication (16.1%), and renewal of topical medication (12%). A total of 19 clinical and non-clinical factors influencing these decisions were identified. More frequent clinical factors included: clinical guidelines (32.7%), deterioration of skin condition (21.2%), improvement of skin condition (20.7%), and side effects of medications (10.6%). More frequent non-clinical factors included: patient’s treatment preferences (9.7%), patient’s concerns (6.9%), quality of life issues (6.5%), patient’s time commitment (6.5%), and treatment compliance problems (4.6%). In this study we have identified the types of management decisions taken in dermatology and the main influences on these decisions. Studying the link between clinical decisions and the influences on these decisions will contribute to better understanding of decision making processes in dermatology, on which better health outcomes depend. [1] Cook SA, Rosser R, James MI et al. (2007) Factors influencing surgeons’ decisions in elective cosmetic surgery consultations. Med Decis Making 27:311–20. [2] Katugampola RP, Hongbo Y, Finlay AY (2005) Clinical management decisions are related to the impact of psoriasis on patient-rated quality of life. Br J Dermatol 152:1256–62