Seite - 127 - in Applied Interdisciplinary Theory in Health Informatics - Knowledge Base for Practitioners

need to send the same message via multiple communication systems due to lack of recipient acknowledgement. Whatever the communication content and format, a junior doctor recipient interprets it in terms of risk for both the patient and to themselves as seen in Figure 1. Risk interpretation is influenced by the recipient’s responsibility and experience. Responsibility is the recipient’s view of their own role, both concerning the perceived patient problem, and the recipient’s relationship with senior doctors. Depending on the junior doctor’s perception of responsibility, especially to senior doctors, the former may still communicate about a patient’s condition despite it being stable. Experience is both the recipient’s clinical experience pertinent to the perceived patient issue, and organisational experience. Increased clinical experience would inform recipient knowledge of when to ask for help. This may also be counterproductive in that junior doctors may not communicate because, while they recognise signs of deterioration, they think they can independently manage the deteriorating patient [14], or that they should be able to [36]. Experience arising from previous professional interaction with other clinicians will influence the responsibility felt by the recipient regarding risk communication, e.g. which senior doctors to call and when. When a junior doctor interprets a communication, this is not purely based on their own view of the patient’s clinical state, or what theoretical evidence there is [37] – it also depends on problem type definition by both the individual and group [38]. Senior doctors from different specialties may have conflicting views, leaving junior doctors in a difficult intermediary position [38]. These views may be idiosyncratic and defy existing evidence [39]. Consequently, junior doctor experience of their senior doctor expectations is just as important as knowledge of treatment evidence. Experience at clinical communication also improves the efficiency of communicating to other clinicians, e.g. determining who is available and accessible. Recipient risk judgment is what finally determines a decision to initiate communication and to whom it should go to. The desire to communicate efficiently rises as perceived risk does, e.g. communication is then likely to be verbal and to clinicians of direct utility for the patient’s care. The interaction of risk, experience, responsibility and efficiency is complex. An example is that junior doctors with high clinical experience may independently resolve a clinical problem, thereby reducing the likelihood of communicating with senior doctors. Alternately, when clinical and organisational experience are high, routine care doctors may be notified even when not immediately involved. Very junior doctors are less likely to recognise deterioration due to their lack of clinical experience and are not as efficient at patient management or communication. They are also not as knowledgeable about who to communicate to due to lack of organisational experience. Combined with low responsibility, such doctors would be very unlikely to escalate a patient. The cumulative effect of the context of usage, the clinical ICT system, the communication that ensues and the recipient’s interpretation of it is what leads to the latter’s decision to initiate further communication. This does not replace the junior doctor’s patient assessment and management. Indeed, junior doctors usually do this prior to communicating [11]. DCMT is primarily about the junior doctor’s decision to communicate to other clinicians. It is less concerned about what the junior doctor can or should obtain from such interaction, e.g. the merits of activating a group emergency call or calling an adjacent colleague. J.Liangetal. / JuniorDoctorCommunicationSystemsand theDCMT 127