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The Role of Physicians’ First Impressions in the Diagnosis of Possible Cancers without Alarm Symptoms

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  • Olga Kostopoulou
  • Miroslav Sirota
  • Thomas Round
  • Shyamalee Samaranayaka
  • Brendan C. Delaney

Abstract

Background. First impressions are thought to exert a disproportionate influence on subsequent judgments; however, their role in medical diagnosis has not been systematically studied. We aimed to elicit and measure the association between first impressions and subsequent diagnoses in common presentations with subtle indications of cancer. Methods. Ninety UK family physicians conducted interactive simulated consultations online, while on the phone with a researcher. They saw 6 patient cases, 3 of which could be cancers. Each cancer case included 2 consultations, whereby each patient consulted again with nonimproving and some new symptoms. After reading an introduction (patient description and presenting problem), physicians could request more information, which the researcher displayed online. In 2 of the possible cancers, physicians thought aloud. Two raters coded independently the physicians’ first utterances (after reading the introduction but before requesting more information) as either acknowledging the possibility of cancer or not. We measured the association of these first impressions with the final diagnoses and management decisions. Results. The raters coded 297 verbalizations with high interrater agreement (Kappa = 0.89). When the possibility of cancer was initially verbalized, the odds of subsequently diagnosing it were on average 5 times higher (odds ratio 4.90 [95% CI 2.72 to 8.84], P

Suggested Citation

  • Olga Kostopoulou & Miroslav Sirota & Thomas Round & Shyamalee Samaranayaka & Brendan C. Delaney, 2017. "The Role of Physicians’ First Impressions in the Diagnosis of Possible Cancers without Alarm Symptoms," Medical Decision Making, , vol. 37(1), pages 9-16, January.
    • Handle: RePEc:sae:medema:v:37:y:2017:i:1:p:9-16
    DOI: 10.1177/0272989X16644563
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    References listed on IDEAS

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    1. DeKay, Michael L. & Miller, Seth A. & Schley, Dan R. & Erford, Breann M., 2014. "Proleader and antitrailer information distortion and their effects on choice and postchoice memory," Organizational Behavior and Human Decision Processes, Elsevier, vol. 125(2), pages 134-150.
    2. repec:cup:judgdm:v:9:y:2014:i:6:p:572-585 is not listed on IDEAS
    3. Russo, J. Edward & Medvec, Victoria Husted & Meloy, Margaret G., 1996. "The Distortion of Information during Decisions," Organizational Behavior and Human Decision Processes, Elsevier, vol. 66(1), pages 102-110, April.
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    1. Yukinori Harada & Shinichi Katsukura & Ren Kawamura & Taro Shimizu, 2021. "Effects of a Differential Diagnosis List of Artificial Intelligence on Differential Diagnoses by Physicians: An Exploratory Analysis of Data from a Randomized Controlled Study," IJERPH, MDPI, vol. 18(11), pages 1-8, May.

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