Non-clinical influences on clinical decision-making: a major challenge to evidence-based practice

F M Hajjaj, M S Salek, M K A Basra, A Y Finlay

Research output: Contribution to journalReview articlepeer-review

138 Citations (Scopus)


This article reviews an aspect of daily clinical practice which is of critical importance in virtually every clinical consultation, but which is seldom formally considered. Non-clinical influences on clinical decision-making profoundly affect medical decisions. These influences include patient-related factors such as socioeconomic status, quality of life and patient's expectations and wishes, physician-related factors such as personal characteristics and interaction with their professional community, and features of clinical practice such as private versus public practice as well as local management policies. This review brings together the different strands of knowledge concerning non-clinical influences on clinical decision-making. This aspect of decision-making may be the biggest obstacle to the reality of practising evidence-based medicine. It needs to be understood in order to develop clinical strategies that will facilitate the practice of evidence-based medicine.

Original languageEnglish
Pages (from-to)178-87
Number of pages10
JournalJournal of the Royal Society of Medicine (JRSM)
Issue number5
Publication statusPublished - May 2010


  • Attitude to Health
  • Decision Making
  • Evidence-Based Medicine
  • Health Services Accessibility
  • Humans
  • Interpersonal Relations
  • Organizational Policy
  • Practice Patterns, Physicians'
  • Prejudice
  • Socioeconomic Factors


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