Why do medical residents prefer paternalistic decision making? An interview study.

Area of Science:

• Medical Education
• Patient-Physician Communication
• Healthcare Decision Making

Background:

• Shared decision making (SDM) is ideal but rarely practiced.
• Residents prefer paternalistic decision making over SDM compared to supervisors.
• Residents' views on decision-making processes and paternalism are largely unknown.

Purpose of the Study:

• To explore residents' perspectives on patient involvement in medical decision-making.
• To identify factors influencing residents' decision-making approaches in consultations.
• To understand the reasons behind residents' preference for paternalistic decision making.

Main Methods:

• Qualitative interviews with 12 residents from diverse specialties.
• Exploration of patient involvement in decision-making during medical encounters.
• Iterative data collection and analysis using constant comparative analysis.

Main Results:

• Residents' engagement of patients was affected by patient characteristics, time constraints, and supervisor input.
• Limited medical and SDM knowledge influenced residents' decision-making.
• Residents believed their responsibility was to provide the correct diagnosis and evidence-based treatment.

Conclusions:

• Residents' decision making is shaped by context, knowledge gaps, and beliefs about their professional duty.
• Residents may misinterpret SDM as obtaining consent or allowing patient choice when evidence is lacking.
• SDM training for residents needs to address both skills and underlying perceptions of their role.