Sociology of Health & Illness, 2008, Volume 30 Issue 3, Pages 429 - 444

Conceptualising the doctor-patient relationship has been a central project for both medicine and medical sociology.  This paper seeks to show how an understanding of the distributed nature of medical practice can help us research the decision-making process in doctor-patient encounters.  I draw on a range of empirical studies of medical interaction, knowledge, technology and work in primary and secondary care.  I describe the ‘ethno-methods’ (Garfinkel 1967) of patient-orientated medical decision making in order to highlight some of the fundamental facets of distributed decision making.  Initially, I outline how decision making is an ongoing event that often evolves over multiple encounters.  I then show how decision making is never just a solo, cognitive, activity but rather distributed over a range of people.  Finally, I outline how decision making is initiated, sustained and transformed over a range of encounters with both people and technologies.  I argue that recognising the distributed nature of decision-making shifts the focus from overly prescriptive visions of decision-making to more plausible, albeit, more mundane sets of ideals.  Centrally, a focus on distribution offers new opportunities to actively engage with, support and research decision-making-in-action.