A systems perspective on clinical management.

A process-tracing descriptive approach is described which is aimed at understanding the clinical management of diabetes mellitus both from the physician's and the patient's perspective. Physician/patient pairs were interviewed about their views of diabetes management. Content analysis and statement classification were used to develop a four-stage model for clinical management which successfully classified 98% of physician statements and 97% of patient statements. Both four-stage models can be combined with a simplified systems description of clinical diabetes to form a unitary systems model for clinical management. Video recording of routine clinic visits with stimulated recall by physicians suggests this systems view of management has considerable heuristic and explanatory potential. A case analysis is presented to illustrate the explanatory value of the systems perspective on difficult management problems.

A scale to measure physician beliefs about psychosocial aspects of patient care.

This report describes the development and initial validation of a self-report instrument designed to measure beliefs about psychosocial aspects of patient care held by primary care physicians. The strategy used was borrowed from psychological measurement: a rational scale was constructed based on an existing theoretical framework concerning the physician's role, what the patient wants and physicians' reactions to their patients as people. The validation step compared scale scores obtained by diverse groups of providers. Psychometric characteristics of the Physician Belief Scale are adequate: scores follow an approximately normal distribution with the mean near the midpoint of possible scores. Lower scores on the Scale represent a more psychosocial approach to patient care. Initial construct validation was successful: physicians from four disciplines obtained scores congruent with expectations about the psychosocial orientations of the disciplines. A reliable and valid measure has been developed to assess physicians' psychosocial beliefs. The instrument may be used to evaluate effectiveness of behavioral science teaching, describing regional or other differences in physician beliefs within and between specialties and estimating changes in provider beliefs.