From Context Comes Expertise: How Do Expert Emergency Physicians Use Their Know-Who to Make Decisions?

Abstract : Study objective: Decision making is influenced by the environment in which it takes place. The objective of our study was to explore the influence of the specific features of the emergency department (ED) environment on decision making. In this paper, we specifically report on the way emergency physicians use their knowledge of their collaborators to make their decisions. Methods: We conducted a qualitative study on emergency physicians recruited in 3 French hospitals. Physicians were equipped with a microcamera to record their clinical activity from their ``own-point-of-view perspective.'' Semistructured interviews, based on viewing the video, were held with each physician after an actual clinical encounter with a patient. They were then analyzed thematically, using constant comparison and matrices, to identify the central themes. Results: Fifteen expert emergency physicians were interviewed. Almost all of them reported using their knowledge of other health care professionals to assess the seriousness of the patient's overall condition (sometimes even before his or her arrival in the ED) to optimize the patient's treatment and to anticipate future care. Conclusion: Emergency physicians interact with many other health care workers during the different stages of the patient's management. The many ways in which experts use their knowledge of other health care professionals to make decisions puts traditional conceptions of expert knowledge into perspective and opens avenues for future research.