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Can medical diagnosis benefit from "unconscious thought"?

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Woolley, Kostopoulou, Delaney MDM 2015.pdfAccepted version220 kBAdobe PDFView/Open
Title: Can medical diagnosis benefit from "unconscious thought"?
Authors: Woolley, A
Kostopoulou, O
Delaney, BC
Item Type: Journal Article
Abstract: © Society for Medical Decision Making.The unconscious thought theory argues that making complex decisions after a period of distraction can lead to better decision quality than deciding either immediately or after conscious deliberation. Two studies have tested this unconscious thought effect (UTE) in clinical diagnosis with conflicting results. The studies used different methodologies and had methodological weaknesses. We attempted to replicate the UTE in medical diagnosis by providing favorable conditions for the effect while maintaining ecological validity. Family physicians (N = 116) diagnosed 3 complex cases in 1 of 3 thinking modes: immediate, unconscious (UT), and conscious (CT). Cases were divided into short sentences, which were presented briefly and sequentially on computer. After each case presentation, the immediate response group gave a diagnosis, the UT group performed a 2-back distraction task for 3 min before giving a diagnosis, and the CT group could take as long as necessary before giving a diagnosis. We found no differences in diagnostic accuracy between groups (P = 0.95). The CT group took a median of 7 s to diagnose, which suggests that physicians were able to diagnose online, as information was being presented. The lack of a difference between the immediate and UT groups suggests that the distraction had no additional effect on performance. To assess the decisiveness of the evidence of this null result, we computed a Bayes factor (BF01) for the 2 comparisons of interest. We found a BF01 of 5.76 for the UT versus immediate comparison and of 3.61 for the UT versus CT comparison. Both BFs provide substantial evidence in favor of the null hypothesis: physicians diagnoses made after distraction are no better than diagnoses made either immediately or after self-paced deliberation.
Issue Date: 7-Apr-2015
Date of Acceptance: 7-Mar-2015
URI: http://hdl.handle.net/10044/1/30843
DOI: https://dx.doi.org/10.1177/0272989X15581352
ISSN: 1552-681X
Publisher: SAGE Publications (UK and US)
Start Page: 541
End Page: 549
Journal / Book Title: Medical Decision Making
Volume: 36
Issue: 4
Copyright Statement: © The Author(s) 2015. The final, definitive version of this paper has been published in Medical Decision Making, 36 (4), 2016 by Sage Publication. It is available at: http://online.sagepub.com/10.1177/0272989X15581352
Keywords: Bayes factor
Clinical reasoning
Deliberation without attention
Dual processes
Family medicine
Unconscious thought effect
Health Policy & Services
Public Health And Health Services
Applied Economics
Publication Status: Published
Conference Place: United States
Appears in Collections:Department of Surgery and Cancer