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

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  • Olga Kostopoulou
  • Christos Mousoulis
  • Brendan Delaney
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    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 coherence-based 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.

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    File URL: http://journal.sjdm.org/9319/jdm9319.pdf
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    Bibliographic Info

    Article provided by Society for Judgment and Decision Making in its journal Judgment and Decision Making.

    Volume (Year): 4 (2009)
    Issue (Month): 5 (August)
    Pages: 408-418

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    Handle: RePEc:jdm:journl:v:4:y:2009:i:5:p:408-418

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    Related research

    Keywords: coherence-based reasoning; cognitive consistency; stimulated recall; diagnostic error; ambiguous information;

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    1. J. Edward Russo & Margaret G. Meloy & T. Jeffrey Wilks, 2000. "Predecisional Distortion of Information by Auditors and Salespersons," Management Science, INFORMS, vol. 46(1), pages 13-27, January.
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    Cited by:
    1. Zwaan, Laura & Thijs, Abel & Wagner, Cordula & Timmermans, Daniƫlle R.M., 2013. "Does inappropriate selectivity in information use relate to diagnostic errors and patient harm? The diagnosis of patients with dyspnea," Social Science & Medicine, Elsevier, vol. 91(C), pages 32-38.

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