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Non-clinical influences in the dermatology consultation: the doctor's perspective and the challenge to evidence based practice [Abstract]

Finlay, Andrew Yule, Hajjaj, Fadi M., Basra, M. K. A. and Salek, Mir-saeed 2011. Non-clinical influences in the dermatology consultation: the doctor's perspective and the challenge to evidence based practice [Abstract]. Acta Dermato-Venereologica 91 (2) , p. 224.

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All clinicians are aware of the reality of clinical decision taking. Many factors and influences affect decision taking; the ability to appropriately consider these influences in the best interests of the patient constitutes the art of medicine. If these influences were better understood, it might be possible to train health care professionals to handle these influences more appropriately and hence improve the quality of clinical decision taking. A variety of influences have been recorded, but there is little specific information relating to dermatology. The aim of the study was to explore the role of nonclinical influences on clinical decision making in dermatology outpatient clinics. Ethical approval was obtained. Forty-six dermatology clinicians (94% of those in Wales) from 9 different hospitals in Wales, UK were interviewed by FMH. The opening question was “According to your experience, what are the nonclinical influences on your decision making in dermatology?”. Interviews were recorded and analysed. Nonclinical influences were either Patient-related, Physician-related or Practice-related. Patient-related factors included adherence to medication (reported by all 46 clinicians), concerns and worries of patient (46), quality of life (46), expectations (45), family and friends attitudes (40), age (38), financial status (30), place of residence (29), ethnicity (28), attitude and behaviour (24), sex (24), time commitments (22), choice (11), and education and intelligence (9). Physician related influences included influence of colleagues (46), time constraints and work pressure (30) and influence of pharmaceutical companies (28). Practice-related influences included cost of treatment to Health Service (27), working in private practice v. Health Service (8), availability of treatment service (7) and bureaucracy in prescribing certain medications (4). It is often appropriate for clinicians to take into account nonclinical influences so that decisions are taken in the best interests of a specific patient; these are “good” influences. However many influences were not necessarily appropriate: the ‘bad” influences. Such inappropriate nonclinical influences might in some circumstances include age, financial status, place of residence, ethnicity, attitude, sex, education, time constraints and influence of pharmaceutical companies. National guidelines seek to improve the quality of clinical decision taking by being evidence based. However in reality guideline advice co-exists with often unrecognised non-clinical influences. If clinicians had greater understanding of the processes involved in decision taking it might be possible to develop strategies to recognise and neutralise the inappropriate influences. Greater understanding of this aspect of decision taking is necessary for evidence based decision taking to become a reality.

Item Type: Article
Status: Published
Schools: Pharmacy
Additional Information: Abstract from: 14th Congress of the European Society for Dermatology and Psychiatry. Zaragoza, Spain. March 17-19, 2007.
ISSN: 0001-5555
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Last Modified: 09 Apr 2019 20:50

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