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Sociol Health Illn. 2008 Apr;30(3):429-44. doi: 10.1111/j.1467-9566.2007.01064.x. Epub 2008 Jan 11.

Distributed decision making: the anatomy of decisions-in-action.

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1
Institute of Health and Society, Newcastle University, UK. tim.rapley@newcastle.ac.uk

Abstract

Conceptualising the doctor-patient relationship has been a central project for both medicine and medical sociology. This paper seeks to show how an understanding of the distributed nature of medical practice can help us research the decision-making process in doctor-patient encounters. I draw on a range of empirical studies of medical interaction, knowledge, technology and work in primary and secondary care. I describe the 'ethno-methods' (Garfinkel 1967) of patient-orientated medical decision making in order to highlight some of the fundamental facets of distributed decision making. Initially, I outline how decision making is an ongoing event that often evolves over multiple encounters. I then show how decision making is never just a solo, cognitive activity but rather distributed over a range of people. Finally, I outline how decision making is initiated, sustained and transformed over a range of encounters with both people and technologies. I argue that recognising the distributed nature of decision making shifts the focus from overly prescriptive visions of decision making to more plausible, albeit, more mundane sets of ideals. Centrally, a focus on distribution offers new opportunities actively to engage with, support and research decision-making-in-action.

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