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Asking for ’rules of thumb’: a way to discover tacit knowledge in general practice
Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Central County Primary Health Care.
Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences.
2002 (English)In: Family Practice, ISSN 0263-2136, Vol. 19, no 6, 617-622 p.Article in journal (Refereed) Published
Abstract [en]

Background. Research in decision-making has identified heuristics (rules of thumb) as shortcuts to simplify search and choice.

Objective. To find out if GPs recognize the use of rules of thumb and if they could describe what they looked like.

Methods. An explorative and descriptive study was set up using focus group interviews. The interview guide contained the questions: Do you recognize the use of rules of thumb? Are you able to give some examples? What are the benefits and dangers in using rules of thumb? Where do they come from? The interviews were transcribed and analysed using the templates in the interview guide, and the examples of rules were classified by editing analysis.

Results. Four groups with 23 GPs were interviewed. GPs recognized using rules of thumb, producing examples covering different aspects of the consultation. The rules for somatic problems were formulated as axiomatic simplified medical knowledge and taken for granted, while rules for psychosocial problems were formulated as expressions of individual experience and were followed by an explanation. The rules seemed unaffected by the sparse objections given. A GP’s clinical experience was judged a prerequisite for applying the rules. The origin of many rules was via word-of-mouth from a colleague. The GPs acknowledged the benefits of using the rules, thereby simplifying work.

Conclusion. GPs recognize the use of rules of thumb as an immediate and semiconscious kind of knowledge that could be called tacit knowledge. Using rules of thumb might explain why practice remains unchanged although educational activities result in more elaborate knowledge.

Place, publisher, year, edition, pages
2002. Vol. 19, no 6, 617-622 p.
Keyword [en]
Decision-making, focus groups, general practice, heuristics
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-13634DOI: 10.1093/fampra/19.6.617OAI: oai:DiVA.org:liu-13634DiVA: diva2:21088
Available from: 2003-03-29 Created: 2003-03-29 Last updated: 2009-08-17
In thesis
1. Rules of Thumb and Management of Common Infections in General Practice
Open this publication in new window or tab >>Rules of Thumb and Management of Common Infections in General Practice
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis deals with problem solving of general practitioners (GPs), which is explored with different methods and from different perspectives. The general aim was to explore and describe rules of thumb and to analyse the management of respiratory and urinary tract infections (RTI and UTI) in general practice in Sweden. The results are based upon focus group interviews concerning rules of thumb and a prospective diagnosis-prescription study concerning the management of patients allocated a diagnosis of RTI or UTI. In addition unpublished data are given from structured telephone interviews concerning specific rules of thumb in acute sinusitis and prevailing cough.

GPs were able to verbalize their rules of thumb, which could be called tacit knowledge. A specific set of rules of thumb was used for rapid assessment when emergency and psychosocial problems were identified. Somatic problems seemed to be the expected, normal state. In the further consultation the rules of thumb seemed to be used in an act of balance between the individual and the general perspective. There was considerable variation between the rules of thumb of different GPs for patients with acute sinusitis and prevailing cough. In their rules of thumb the GPs seemed to integrate their medical knowledge and practical experience of the consultation. A high number of near-patient antigen tests to probe Streptococcus pyogenes (Strep A tests) and C-reactive protein (CRP) tests were performed in patients, where testing was not recommended. There was only a slight decrease in antibiotic prescribing in patients allocated a diagnosis of RTI examined with CRP in comparison with patients not tested. In general, the GPs in Sweden adhered to current guidelines for antibiotic prescribing. Phenoxymethylpenicillin (PcV) was the preferred antibiotic for most patients allocated a diagnosis of respiratory tract infection.

In conclusion, the use of rules of thumb might explain why current practices prevail in spite of educational efforts. One way to change practice could be to identify and evaluate rules of thumb used by GPs and disseminate well adapted rules. The use of diagnostic tests in patients with infectious illnesses in general practice needs critical appraisal before introduction as well as continuing surveillance. The use of rules of thumb by GPs might be one explanation for variation in practice and irrational prescribing of antibiotics in patients with infectious conditions.

Place, publisher, year, edition, pages
Institutionen för hälsa och samhälle, 2004
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 840
Keyword
General practice, rules of thumb, decision making, respiratory tract infections, urinary tract infections, diagnostic tests, C-reactive protein test, antibiotic prescribing
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:liu:diva-5183 (URN)91-7373-812-3 (ISBN)
Public defence
2004-03-12, Aulan, Hälsans hus, Campus US, Linköpings universitet, Linköping, 13:00 (English)
Opponent
Note
On the day of the public defence the status of the articles IV and V was: Accepted.Available from: 2003-03-29 Created: 2003-03-29

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André, MalinBorgquist, LarsFoldevi, MatsMölstad, Sigvard

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Department of Medicine and Health SciencesFaculty of Health SciencesUnit of Research and Development in Local Health Care, County of ÖstergötlandCentral County Primary Health Care
Medical and Health Sciences

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