Management reasoning and patient-clinician interactions: Insights from shared decision-making and simulated outpatient encounters

David A. Cook*, Ian G. Hargraves, Christopher R. Stephenson, Steven J. Durning

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Purpose: To expand understanding of patient-clinician interactions in management reasoning. Methods: We reviewed 10 videos of simulated patient-clinician encounters to identify instances of problematic and successful communication, then reviewed the videos again through the lens of two models of shared decision-making (SDM): an ‘involvement-focused’ model and a ‘problem-focused’ model. Using constant comparative qualitative analysis we explored the connections between these patient-clinician interactions and management reasoning. Results: Problems in patient-clinician interactions included failures to: encourage patient autonomy; invite the patient’s involvement in decision-making; convey the health impact of the problem; explore and address concerns and questions; explore the context of decision-making (including patient preferences); meet the patient where they are; integrate situational preferences and priorities; offer >1 viable option; work with the patient to solve a problem of mutual concern; explicitly agree to a final care plan; and build the patient-clinician relationship. Clinicians’ ‘management scripts‘ varied along a continuum of prioritizing clinician vs patient needs. Patients also have their own cognitive scripts that guide their interactions with clinicians. The involvement-focused and problem-focused SDM models illuminated distinct, complementary issues. Conclusions: Management reasoning is a deliberative interaction occurring in the space between individuals. Juxtaposing management reasoning alongside SDM generated numerous insights.

Original languageEnglish
Pages (from-to)1025-1037
Number of pages13
JournalMedical Teacher
Issue number9
StatePublished - 2023
Externally publishedYes


  • Decision Making
  • clinical decision-making
  • communication
  • diagnostic reasoning
  • shared
  • therapeutic reasoning


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