'Thinking aloud' as a method of analysing the treatment decisions of physicians

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Abstract
The feasibility of studying the decision-making process of physicians with the ‘thinking aloud’ method was tested in a study of 33 physicians. On 2 occasions 3 months apart the study subjects were asked for their management of 2 duplicate sets of 5 patients. On 1 occasion they either had to think aloud when making their decision, or they had to give a retrospective report of their decision-making process. The verbalized thoughts and retrospective reports were analysed to search for different decision-making strategies. In 2 relatively simple cases (women with urinary tract infections), the thinking aloud method showed a decision process with little deliberation about the treatment, suggesting the use of rules-of-thumb or routine behaviour. Thinking aloud during more complex cases (stomach and reflux complaints) showed more comparative and absolute evaluations of possible management and treatment options. This differentiation in strategies did not emerge from the retrospective reports. The inconsistency in the repeated treatment choices was about 27%. Thinking aloud did not significantly increase this inconsistency. It is concluded that thinking aloud is a useful method of analysing treatment decisions.

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