Clinical Solutions: Factors and Problematic Situations from the Perspective of Doctors in a Large Russian City

Abstract

This article focuses on the main results of a quantitative empirical study of clinical decisions made by doctors in medical institutions of various profiles in a large Russian city. The study was conducted in 2019 and is based on the results of the previous qualitative analysis stage — within the research “mix-strategy”. The main point of analytical interest is the factors which influence the doctors’ clinical decisions in two basic clinical situations — in the situation of disease diagnosis and in the situation of treatment prescription. The object of the research was doctors from Samara medical clinics. Factors and decisions made by doctors were studied from the point of view of doctors themselves. The degree of influence of each factor on the decisions made by doctors was assessed with the help of the Influence Index, an integral index on a fully ordered scale. The article presents a hierarchy of factors influencing medical decision-making in diagnosis and treatment situations; the top group of factors in both situations is identified and interpreted. At the same time, additional problematic situations were studied in the research. In particular, the range of clinical decisions and factors determining them, in case of it being necessary to conduct an examination not provided by standard state medical care, in a situation when this examination is provided, but the limit of prescriptions is exhausted, in a situation when the medical institution (hospital) does not have the best quality medication for the patient in the quantities needed, in a situation when the state standard on a specific nosology is ineffective for a specific patient, as well as other problematic situations.

Keywords

• sociology of medicine
• clinical decisions
• diagnostics
• treatment prescription
• influence factors
• problem situations