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• W2896435906 abstract "In 2006, Sandhu et al1Sandhu H. Carpenter C. Freeman K. et al.Clinical decisionmaking: opening the black box of cognitive reasoning.Ann Emerg Med. 2006; 48: 713-719Abstract Full Text Full Text PDF PubMed Scopus (59) Google Scholar called for researchers to undertake more studies to understand how emergency physicians make their decisions. The study by Wright et al2Wright B. Martin G.P. Ahmed A. et al.How the availability of observation status affects emergency physician decisionmaking.Ann Emerg Med. 2018; 72: 401-409Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar sheds new light on this field of research in terms of the weight of experience and the role of context in decisionmaking. The results concerning the percentage of risk of an adverse outcome that leads emergency physicians to place patients under observation and its variability from one physician to another, the influence of the horror stories experienced or heard by a physician on his or her decision, and the discrepancy between the statements of emergency physicians about their preference for a particular process and the reality of their reasoning2Wright B. Martin G.P. Ahmed A. et al.How the availability of observation status affects emergency physician decisionmaking.Ann Emerg Med. 2018; 72: 401-409Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar show the crucial role played by the physician’s experience on how decisions are made. This “individualization” of decisionmaking mechanisms seems to be reinforced by the influence of personal factors such as risk aversion.2Wright B. Martin G.P. Ahmed A. et al.How the availability of observation status affects emergency physician decisionmaking.Ann Emerg Med. 2018; 72: 401-409Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar From a contextual standpoint, the results discussed by Wright et al tend to confirm research that postulates that context has a major influence on decisionmaking.3Durning S. Artino Jr., A.R. Pangaro L.N. et al.Context and clinical reasoning: understanding the perspective of the expert’s voice.Med Educ. 2011; 45: 927-938Crossref PubMed Scopus (126) Google Scholar, 4Pelaccia T. Tardif J. Triby E. et al.From context comes expertise: how do expert emergency physicians use their know-how to make decisions?.Ann Emerg Med. 2016; 67: 747-751Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar The heuristics used by emergency physicians included in the study to manage patients with abdominal pain would thus likely be very different in other, less acute contexts of medical practice. The authors have shown that these mechanisms are above all intuitive and therefore irrepressibly mobilized, which demonstrates the very high level of internalization of the specificities and requirements linked to the context; in this case, in regard to the need for risk stratification in emergency departments. All these elements underline the plurifactorial and multidimensional nature of decisionmaking, which legitimates a move away from the experimental dogma toward the conduct of research on decisionmaking in context and the interpretation of the results of this research in regard to a context and its specificities. This contextualized approach involves implementing specific data collection and analysis techniques to enable emergency physicians to make their reasoning explicit in the situation, and not simply to express an opinion or share their representation of what their reasoning is or should be. The results of the study by Wright et al lead us to conclude that1.the cognitive processes described within the framework of the dual process theory are certainly “universal”5Croskerry P. A universal model of diagnostic reasoning.Acad Med. 2009; 84: 1022-1028Crossref PubMed Scopus (556) Google Scholar because they are consistently found in research based on this framework, but the way in which they are mobilized and the result of this mobilization are strongly contextually anchored; and2.clinical reasoning is first and foremost a story of an individual’s experiences in a context, which highlights the highly idiosyncratic nature of decisionmaking, far removed from an idealized and frequently prescribed approach of Bayesian evidence-based reasoning. These results are finally a new opportunity to launch a call to continue and intensify research in the field of emergency medicine decisionmaking because there is such a great need for understanding in this field and the results of this research are such as to enlighten the practices and training of emergency physicians. How the Availability of Observation Status Affects Emergency Physician DecisionmakingAnnals of Emergency MedicineVol. 72Issue 4PreviewThis study seeks to understand how emergency physicians decide to use observation services, and how placing a patient under observation influences physicians’ subsequent decisionmaking. Full-Text PDF In reply:Annals of Emergency MedicineVol. 72Issue 5PreviewWe appreciate the opportunity to respond to Dr. Pelaccia’s letter,1 which sought to draw some important conclusions for the field of emergency medicine decisionmaking from our recent article.2 Full-Text PDF" @default.
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• W2896435906 date "2018-11-01" @default.
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• W2896435906 title "Decisionmaking in Emergency Medicine: Experienced-Based and Contextually Anchored Rather Than Evidence Based and Universal" @default.
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• W2896435906 doi "https://doi.org/10.1016/j.annemergmed.2018.07.010" @default.
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