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


  • Olga Kostopoulou
  • Christos Mousoulis
  • Brendan Delaney


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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  • Olga Kostopoulou & Christos Mousoulis & Brendan Delaney, 2009. "Information search and information distortion in the diagnosis of an ambiguous presentation," Judgment and Decision Making, Society for Judgment and Decision Making, vol. 4(5), pages 408-418, August.
  • Handle: RePEc:jdm:journl:v:4:y:2009:i:5:p:408-418

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    References listed on IDEAS

    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. Martine Nurek & Olga Kostopoulou & York Hagmayer, 2014. "Predecisional information distortion in physicians' diagnostic judgments: Strengthening a leading hypothesis or weakening its competitor?," Judgment and Decision Making, Society for Judgment and Decision Making, vol. 9(6), pages 572-585, November.
    2. 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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