"And I think that we can fix it": mental models used in high-risk surgical decision making

Annals of Surgery
Jacqueline M KruserMargaret L Schwarze

Abstract

To examine how surgeons use the "fix-it" model to communicate with patients before high-risk operations. The "fix-it" model characterizes disease as an isolated abnormality that can be restored to normal form and function through medical intervention. This mental model is familiar to patients and physicians, but it is ineffective for chronic conditions and treatments that cannot achieve normalcy. Overuse may lead to permissive decision making favoring intervention. Efforts to improve surgical decision making will need to consider how mental models function in clinical practice, including "fix-it." We observed surgeons who routinely perform high-risk surgery during preoperative discussions with patients. We used qualitative content analysis to explore the use of "fix-it" in 48 audio-recorded conversations. Surgeons used the "fix-it" model for 2 separate purposes during preoperative conversations: (1) as an explanatory tool to facilitate patient understanding of disease and surgery, and (2) as a deliberation framework to assist in decision making. Although surgeons commonly used "fix-it" as an explanatory model, surgeons explicitly discussed limitations of the "fix-it" model as an independent rationale for operating as they delib...Continue Reading

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Citations

Sep 18, 2016·Annals of Surgical Oncology·Megan WinnerTimothy M Pawlik
Aug 23, 2017·Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery·Nikhila RaolMegan A Morris
Oct 21, 2015·Journal of the American Geriatrics Society·Alexander K SmithKenneth E Covinsky
Jan 8, 2019·The American Journal of Hospice & Palliative Care·Holly B CunninghamHerb A Phelan
Dec 15, 2017·Annals of Surgery·Justin T ClappLee A Fleisher
Oct 30, 2016·Journal of Surgical Oncology·Megan WinnerTimothy M Pawlik
Nov 14, 2015·Annals of Surgery·Lauren J Taylor, Margaret L Schwarze
Aug 29, 2020·Palliative & Supportive Care·Elizabeth Palmer KellyTimothy M Pawlik
Aug 19, 2015·Journal of the American Geriatrics Society·Jacqueline M KruserMargaret L Schwarze
Nov 23, 2017·Medical Decision Making : an International Journal of the Society for Medical Decision Making·Shannon HalikoAmber E Barnato
Jul 5, 2018·Journal of Perinatology : Official Journal of the California Perinatal Association·Brian M CummingsMichael P Moreland
Dec 21, 2016·Annals of the American Thoracic Society·Jacqueline M KruserMargaret L Schwarze
May 18, 2018·Journal of Burn Care & Research : Official Publication of the American Burn Association·Holly B CunninghamHerb A Phelan
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Jun 16, 2021·Journal of Palliative Medicine·Lindsay K HainesNiels D Martin
May 10, 2019·Journal of Vascular Surgery·Jun Xu, Anya E R Prince

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