Influences of early diagnostic suggestions on clinical reasoning
Abstract Previous research has highlighted the importance of physicians’ early hypotheses for their subsequent diagnostic decisions. It has also been shown that diagnostic accuracy improves when physicians are presented with a list of diagnostic suggestions to consider at the start of the clinical e...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2022-12-01
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| Series: | Cognitive Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s41235-022-00453-y |
| _version_ | 1828265714050400256 |
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| author | Ploutarchos Kourtidis Martine Nurek Brendan Delaney Olga Kostopoulou |
| author_facet | Ploutarchos Kourtidis Martine Nurek Brendan Delaney Olga Kostopoulou |
| author_sort | Ploutarchos Kourtidis |
| collection | DOAJ |
| description | Abstract Previous research has highlighted the importance of physicians’ early hypotheses for their subsequent diagnostic decisions. It has also been shown that diagnostic accuracy improves when physicians are presented with a list of diagnostic suggestions to consider at the start of the clinical encounter. The psychological mechanisms underlying this improvement in accuracy are hypothesised. It is possible that the provision of diagnostic suggestions disrupts physicians’ intuitive thinking and reduces their certainty in their initial diagnostic hypotheses. This may encourage them to seek more information before reaching a diagnostic conclusion, evaluate this information more objectively, and be more open to changing their initial hypotheses. Three online experiments explored the effects of early diagnostic suggestions, provided by a hypothetical decision aid, on different aspects of the diagnostic reasoning process. Family physicians assessed up to two patient scenarios with and without suggestions. We measured effects on certainty about the initial diagnosis, information search and evaluation, and frequency of diagnostic changes. We did not find a clear and consistent effect of suggestions and detected mainly non-significant trends, some in the expected direction. We also detected a potential biasing effect: when the most likely diagnosis was included in the list of suggestions (vs. not included), physicians who gave that diagnosis initially, tended to request less information, evaluate it as more supportive of their diagnosis, become more certain about it, and change it less frequently when encountering new but ambiguous information; in other words, they seemed to validate rather than question their initial hypothesis. We conclude that further research using different methodologies and more realistic experimental situations is required to uncover both the beneficial and biasing effects of early diagnostic suggestions. |
| first_indexed | 2024-04-13T04:42:50Z |
| format | Article |
| id | doaj.art-ebceedd2df1a46428f73a3b4a0c13a53 |
| institution | Directory Open Access Journal |
| issn | 2365-7464 |
| language | English |
| last_indexed | 2024-04-13T04:42:50Z |
| publishDate | 2022-12-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Cognitive Research |
| spelling | doaj.art-ebceedd2df1a46428f73a3b4a0c13a532022-12-22T03:01:56ZengSpringerOpenCognitive Research2365-74642022-12-017111710.1186/s41235-022-00453-yInfluences of early diagnostic suggestions on clinical reasoningPloutarchos Kourtidis0Martine Nurek1Brendan Delaney2Olga Kostopoulou3Imperial College LondonImperial College LondonImperial College LondonImperial College LondonAbstract Previous research has highlighted the importance of physicians’ early hypotheses for their subsequent diagnostic decisions. It has also been shown that diagnostic accuracy improves when physicians are presented with a list of diagnostic suggestions to consider at the start of the clinical encounter. The psychological mechanisms underlying this improvement in accuracy are hypothesised. It is possible that the provision of diagnostic suggestions disrupts physicians’ intuitive thinking and reduces their certainty in their initial diagnostic hypotheses. This may encourage them to seek more information before reaching a diagnostic conclusion, evaluate this information more objectively, and be more open to changing their initial hypotheses. Three online experiments explored the effects of early diagnostic suggestions, provided by a hypothetical decision aid, on different aspects of the diagnostic reasoning process. Family physicians assessed up to two patient scenarios with and without suggestions. We measured effects on certainty about the initial diagnosis, information search and evaluation, and frequency of diagnostic changes. We did not find a clear and consistent effect of suggestions and detected mainly non-significant trends, some in the expected direction. We also detected a potential biasing effect: when the most likely diagnosis was included in the list of suggestions (vs. not included), physicians who gave that diagnosis initially, tended to request less information, evaluate it as more supportive of their diagnosis, become more certain about it, and change it less frequently when encountering new but ambiguous information; in other words, they seemed to validate rather than question their initial hypothesis. We conclude that further research using different methodologies and more realistic experimental situations is required to uncover both the beneficial and biasing effects of early diagnostic suggestions.https://doi.org/10.1186/s41235-022-00453-yDiagnosisConfidenceInformation searchInformation evaluationResistance to changeDecision aids |
| spellingShingle | Ploutarchos Kourtidis Martine Nurek Brendan Delaney Olga Kostopoulou Influences of early diagnostic suggestions on clinical reasoning Cognitive Research Diagnosis Confidence Information search Information evaluation Resistance to change Decision aids |
| title | Influences of early diagnostic suggestions on clinical reasoning |
| title_full | Influences of early diagnostic suggestions on clinical reasoning |
| title_fullStr | Influences of early diagnostic suggestions on clinical reasoning |
| title_full_unstemmed | Influences of early diagnostic suggestions on clinical reasoning |
| title_short | Influences of early diagnostic suggestions on clinical reasoning |
| title_sort | influences of early diagnostic suggestions on clinical reasoning |
| topic | Diagnosis Confidence Information search Information evaluation Resistance to change Decision aids |
| url | https://doi.org/10.1186/s41235-022-00453-y |
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