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A systems perspective on clinical management.

A process-tracing descriptive approach is described which is aimed at understanding the clinical management of diabetes mellitus both from the physician's and the patient's perspective. Physician/patient pairs were interviewed about their views of diabetes management. Content analysis and statement classification were used to develop a four-stage model for clinical management which successfully classified 98% of physician statements and 97% of patient statements. Both four-stage models can be combined with a simplified systems description of clinical diabetes to form a unitary systems model for clinical management. Video recording of routine clinic visits with stimulated recall by physicians suggests this systems view of management has considerable heuristic and explanatory potential. A case analysis is presented to illustrate the explanatory value of the systems perspective on difficult management problems.