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Is certainty more important than diagnosis for understanding race and gender disparities?: An experiment using coronary heart disease and depression case vignettes

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  • Lutfey, Karen E.
  • Link, Carol L.
  • Grant, Richard W.
  • Marceau, Lisa D.
  • McKinlay, John B.
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    Abstract

    Objectives To (1) examine the influence of patient and provider attributes on physicians' diagnostic certainty and (2) assess the effect of diagnostic certainty on clinical therapeutic actions.Methods Factorial experiment of 128 generalist physicians using identical clinically authentic videotaped vignettes depicting patients with coronary heart disease (CHD) or depression.Results For CHD, physicians were least certain for Black patients (p=.003) and for younger female patients (p=.013). For depression, average certainty was higher than for the CHD presentation (74.0 vs. 57.9 on of scale of 0-100, p

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    Bibliographic Info

    Article provided by Elsevier in its journal Health Policy.

    Volume (Year): 89 (2009)
    Issue (Month): 3 (March)
    Pages: 279-287

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    Handle: RePEc:eee:hepoli:v:89:y:2009:i:3:p:279-287

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    Web page: http://www.elsevier.com/locate/healthpol

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    Keywords: Clinical decision-making Health disparities Certainty CHD Depression;

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    1. Balsa, Ana I. & McGuire, Thomas G., 2003. "Prejudice, clinical uncertainty and stereotyping as sources of health disparities," Journal of Health Economics, Elsevier, vol. 22(1), pages 89-116, January.
    2. Balsa, Ana I. & McGuire, Thomas G., 2001. "Statistical discrimination in health care," Journal of Health Economics, Elsevier, vol. 20(6), pages 881-907, November.
    3. van Ryn, Michelle & Burke, Jane, 2000. "The effect of patient race and socio-economic status on physicians' perceptions of patients," Social Science & Medicine, Elsevier, vol. 50(6), pages 813-828, March.
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