COLLABORATIVE PROBLEM-SOLVING IN TELEMEDICINE AND EVIDENCE INTERPRETATION IN A COMPLEX CLINICAL CASE

This study examined clinical problem-solving processes in the context of a telemedical consultation, in order to verify to what extent the t echnological environment preserves the characteristics of medical reas oning that are known to occur in more traditional clinical settings. T his study also provided an opportunity for examining certain fundament al aspects of medical reasoning about complex cases. Within a case-stu dy design, we used a theoretical framework and qualitative methods ori ginating from cognitive science. Expert physicians used reasoning stra tegies commensurate with the complexity of the case. The technological context of the telemedical consultation did not overly contrive the i nteraction, allowing them to use real-time problem-solving processes c haracterizing medical reasoning in naturalistic settings. The results also suggest that high levels of expertise in the presence of very com plex cases may elicit a particular configuration of problem-solving pr ocesses, associating certain reasoning patterns that are usually relat ed to non-expert problem-solving with others that are typical of exper tise. We believe that the evaluation of image transmission and diagnos tic performance in telemedicine, as well as the determination of its i ndications and technological configurations, may benefit from taking i nto account, with the help of cognitive methodologies, the interacting problem-solving modalities that may be encountered in this context. ( C) 1998 Elsevier Science Ireland Ltd. All rights reserved.