74 Chapter 4 meetings showed that patient characteristics were mentioned more frequently during meetings where more time was spent discussing an individual patient. [32] The current study setup is not designed to show such causalities. In light of these previous study results, however, it is plausible that the way patient workup was organized might be limiting the proper use of SDM principles. Another study suggests a need to explicitly voice patient preferences. It showed that in a minority of oncology consultations for rectal cancer, this actually happened, yet whenever it did, this increased patients’ perceived involvement in the decision-making process significantly. [34] Strengths and weaknesses of this study A strength has been that this was an observational study, so this study is able to report on what doctors actually do rather than what doctors say they do. Hospital ethnography is a scientific approach tailored to study culture, and thus, it is the appropriate method for answering the research question. As in most qualitative research, there is, however, a certain level of subjectivity due to the personal impact on what is observed, noted down, and interpreted. In this study, this was compensated by using an insider-outsider construction. This construction proved to be a great advantage. The insider perspective facilitated quick and easy access to the work field. It also facilitated the understanding of medical jargon and processes and accelerated the establishment of a relationship between the field and researchers. While the insider might have been cultivated too much in training, the outsider compensated for this by being new to the field of medicine. Furthermore, an experienced hospital ethnographer was used to supervise the process, help interpret findings, and minimize bias. Data obtained in this study were linked to existing literature on culture and SDM throughout the data collection. Furthermore, a well-established social sciences theory was used, which made it easier to analyze features of physician culture. Bourdieu has been used before in describing cultural elements in healthcare. [35] What is new in this study, however, is that his theory is applied to analyze culture amongst doctors specifically. A big disadvantage of observational studies, in general, is the lack of generalizability of study results, as phenomena observed seem legit for the field under observation but not necessarily so for all other fields. However, there might still be a generalizability of concepts, [36] as field and capital share similarities between different hospitals. Therefore, insights gained in elements from doctors’ habitus – and how this may affect SDM - in this study could still enhance understanding of similar dynamics in other situations as well. Strengths and weaknesses of this study in relation to other studies To the best of our knowledge, this is the first observational study that evaluates physician culture in relation to SDM. Other studies looking at physician culture in relation to physician
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