Methodological considerations in analysing anaesthetists' habits of actionin clinical situations

Human activity can be seen as an intentional, context-dependent enterprise explained through meanings the actors attach to their activity and their di rectly observable interactions with the environment. The authors have demon strated previously a new conceptual framework to describe the anaesthetist' s activity. One of the central concepts besides orientation is habit of act ion referring to the way in which the actor has organized his actions when interacting with his environment, in this case a patient with unique physio logical potentials, information monitors and anaesthetic drugs. The activit y dependent on contingent, particular circumstances, needs to be studied as it appears in a natural situation. Using an idiographic study design the a uthors have examined the activity of eight expert anaesthetists in clinical settings to determine the characteristics of their habits of action. To ca pture the fleeting circumstances during the anaesthetic process, a wide obs ervational basis was necessary. It consisted of videotapes, detailed expert observations, and interviews. The conceptual analysis of the subject, habi t of action, is described step-by-step. Two distinct habits of action could be identified, confirming earlier results. The interpretative habit of act ion was characterized by extensive use of situational information in order to construct a cumulative conception of the patient's physiological potenti als to control the process accurately. Moreover, rich dialogue between form al professional knowledge and patient-specific, particular knowledge was ev ident. The reactive habit of action was characterized by a tendency to regu late the process by means of predetermined conventional ranges of measured patient parameters shown by monitors. The authors discuss their methodologi cal solutions and results, and explicate their differences to the earlier a pproaches.