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Information search and information distortion in the diagnosis of an ambiguous presentation

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Title: Information search and information distortion in the diagnosis of an ambiguous presentation
Authors: Kostopoulou, O
Mousoulis, C
Delaney, BC
Item Type: Journal Article
Abstract: Physicians often encounter diagnostic problems with ambiguous and conflicting features. What are they likely to do in such situations? We presented a diagnostic scenario to 84 family physicians and traced their information gathering, diagnoses and management. The scenario contained an ambiguous feature, while the other features supported either a cardiac or a musculoskeletal diagnosis. Due to the risk of death, the cardiac diagnosis should be considered and managed appropriately. Forty-seven participants (56%) gave only a musculoskeletal diagnosis and 45 of them managed the patient inappropriately (sent him home with painkillers). They elicited less information and spent less time on the scenario than those who diagnosed a cardiac cause. No feedback was provided to participants. Stimulated recall with 52 of the physicians revealed differences in the way that the same information was interpreted as a function of the final diagnosis. The musculoskeletal group denigrated important cues, making them coherent with their representation of a pulled muscle, whilst the cardiac group saw them as evidence for a cardiac problem. Most physicians indicated that they were fairly or very certain about their diagnosis. The observed behaviours can be described as coherencebased reasoning, whereby an emerging judgment influences the evaluation of incoming information, so that confident judgments can be achieved even with ambiguous, uncertain and conflicting information. The role of coherence-based reasoning in medical diagnosis and diagnostic error needs to be systematically examined.
Issue Date: 2-Aug-2009
Date of Acceptance: 1-Aug-2009
URI: http://hdl.handle.net/10044/1/25408
ISSN: 1930-2975
Publisher: Society for Judgment and Decision Making
Start Page: 408
End Page: 418
Journal / Book Title: Judgment and Decision Making
Volume: 4
Issue: 5
Copyright Statement: © 2009 the Authors
Publication Status: Published
Appears in Collections:Department of Surgery and Cancer