Salloch Sabine, Otte Ina, Reinacher-Schick Anke, Vollmann Jochen
Institute for Ethics and History of Medicine, University Medicine Greifswald, Greifswald, Germany.
Institute for Medical Ethics and History of Medicine, Ruhr-University Bochum, Bochum, Germany.
J Eval Clin Pract. 2018 Feb;24(1):180-186. doi: 10.1111/jep.12840. Epub 2017 Oct 27.
Physicians' clinical expertise forms an exclusive body of competences, which helps them to find the appropriate diagnostics and treatment for each individual patient. Empirical evidence, however, suggests that there is an inverse relationship between the number of years in practice and the quality of care provided by a physician. Knowledge and adherence to professional standards (such as clinical guidelines) are often used as indicators in previous research.
Semistructured interviews and the Q method were used for an explorative study on oncologists' views on the interplay between their own clinical expertise, intuition, and the external evidence incorporated in clinical guidelines. The interviews were audio recorded, transcribed ad verbatim, and analysed using qualitative content analysis.
Data analysis shows the complex character of clinical expertise with respect to experience, professional development, and intuition. An irreplaceable role is attributed to personal and bodily experience during the providing of care for a patient. Professional experience becomes important, particularly in those situations that lie out of the focus of "guideline medicine." Intuition is regarded as having a strong emotional component and helps for deciding which therapeutic option the patient can deal with.
Using measurable knowledge and adherence to standards as indicators does not account for the complexity of clinical expertise. Other factors, such as the importance of bodily experience and physicians' intuitive knowledge, must be considered, also with respect to the occurrence of treatment biases.
医生的临床专业技能构成了一套独特的能力体系，有助于他们为每位患者找到合适的诊断和治疗方法。然而，实证证据表明，医生的执业年限与所提供医疗服务的质量之间存在反比关系。在以往的研究中，知识和对专业标准（如临床指南）的遵循常被用作指标。
采用半结构化访谈和Q方法，对肿瘤学家关于自身临床专业技能、直觉与临床指南中纳入的外部证据之间相互作用的观点进行探索性研究。访谈进行了录音，逐字转录，并采用定性内容分析进行分析。
数据分析显示了临床专业技能在经验、专业发展和直觉方面的复杂特性。在为患者提供护理过程中，个人和身体经验具有不可替代的作用。专业经验变得很重要，尤其是在那些不属于“指南医学”关注焦点的情况下。直觉被认为具有强烈的情感成分，有助于决定患者能够接受哪种治疗选择。
将可衡量的知识和对标准的遵循用作指标并不能解释临床专业技能的复杂性。必须考虑其他因素，如身体经验的重要性和医生的直觉知识，同时也要考虑治疗偏差的发生情况。
