Physician decision making over the telephone

Physician decision-making behaviors were evaluated for 31 telephone encounters between trained patient simulators and 9 first-year residents, 11 third-year residents, and 8 practicing physicians on after-hours call. The following trends occur as physicians become more experienced: mean call length decreases, less time is spent on diagnosis, fewer diagnostic questions are asked, greater time is spent on management, and diagnostic reasoning becomes more intuitive. These findings suggest that previous models of good telephone decision making, which focused on empirical data collection, may not represent the process used by experienced physicians.