Medical decision making and intra-professional negotiation: an analytical model
Sociology ISEG/SOCIUS Lisboa, Portugal
Medical decision making constitutes the most complete exercise of medical power. It is itself a kind of aim, almost synonyms of the medical professions? mission: to treat the patient. Then, the several moments of medical decision making results from the construction between different medical knowledge and discourses, approaches and strategies that cross each other and materialise in medical practices.
This way, from an ethnographic study in a hospital unit of liver transplantation, this paper analyses and discuss the medical decision making processes around the patients? access to hepatic transplantation, standing out the complexity of negotiation processes between the medical specialities involved.
A qualitative methodological approach was adopted, in which we opted for a central technique, participant observation and, as a complementary technique, semi-structured and in-depth interviews. Continuous participant observation extended over a period of roughly seven months. This was subsequently followed by semi-structured and in-depth interviews involving all the medical specialities under observation. This paper presents some findings concerning medical decision making on the patients access to hepatic transplantation, by exploring the issues related to the management of risk and uncertainty. The findings highlight the role of medical discourse in the construction of medical decision making and the strategic alliances around consensus.
The key theoretical guidelines are drawn from the sociology of professions, and medical sociology, particularly the social constructivist approaches. Assuming as starting point the limitations of the classic decision making models, where decision making is seen as a rational model, this paper enhance the plural nature of the medical decision making processes and their relationships with the contexts of action associated to them. We suggest an analytical model to the study of medical decision making and intraprofessional negotiation, by standing out the relations between knowledge and discourse in the construction of power strategies. This way we intend to scrutinize medical practice leaded by actors in social contexts and not only as technical interventions.