Four factors of clinical decision making: a teaching model

For more than 25 years, Bowman Gray has been placing fourth-year students in community-based primary care settings. Upon their return to campus, the students participate in a seminar in which they discuss issues raised by their primary care experiences. In these seminars, the students have consistently identified four key factors of clinical decision making that reflect current trends in medicine: quality, cost, ethics, and legal concerns. These factors influence the practice of medicine and affect the health care of individuals and communities. The authors discuss the nature of these factors and the physician's role and obligation in clinical decision making. Physicians have two responsibilities in this decision-making model: to be the primary advocates for quality health care and to ensure that there be a balance among the weights given the four factors. While physicians must take the lead in ensuring quality care, they must work in partnership with patients, payers, lawyers, ethicists, and the government. It is up to those responsible for the education of future physicians to see that students understand all the factors of clinical decision making and how best to balance them to fulfill their future obligations to patients.