Table 2

 Quotes from surgeons discussing decision making

Decision-making methodQuote
RPD, recognition-primed decision making.
Considering options Intuitive (RPD)“I am under extreme time pressure—there is no time to make decisions—the bleeding must be controlled rapidly and I have 20 minutes before the kidney dies. I tell the anaesthetist immediately as I find the source of bleeding and arrange for it to be clamped. I need to keep the good kidney alive so get some cold saline into the kidney.”
Rule based“If damage is occurring then you want to stop, especially according to clinical governance guidelines. Part of the expertise lies in doing but the other part is recognising when you are struggling and knowing that ‘first do no harm’ so I decided to stop and get a second opinion.”
Analytical“There were three options to consider and at this stage we had to balance the potential risk of problems in the post-op phase with the risks of doing something intraoperatively.”