Managing inconsistencies in medical decision-making: An eight-fold typology

Abstract

This paper serves to deepen the understanding of how inconsistencies between feeling, thinking, and doing are managed by decision-makers in emergency settings. We use a practice approach and investigate the emergency physicians in an Emergency Department (ED), by means of 200 h of observations, 12 in-depth interviews, and organizational documentation. Data are analyzed using an abductive template-based approach. The configuration of three different decision-making modes, namely an experiential-based mode, an ostensive-based mode, and an action-based mode, provide an eight-fold typology of emergency physicians' decision-making praxis. “Weak” signals are the starting point for clinical assessment, and inconsistencies among the modes are strategically used and surprisingly often associated with positive treatment outcomes. The praxis perspective used in this article bridges literature on choice and interpretation—processes usually separated in organizational and decision-making literature. Inconsistency between the modes allow physicians to create an action space where decision-making is about more than providing the “right” answer. Making use of the eight-fold typology helps physicians identify “blind spots”, improve practice in both mundane and medically rare cases, as well as aid in revision of existing routines. This awareness also provides for high-quality care, an increased acceptance of inconsistencies by the public, with a potential to reduce litigation issues.