Influence of psychiatric or social backgrounds on clinical decision making: a randomized, controlled multi-centre study

Abstract

BackgroundFrequent and repeated visits from patients with mental illness or free medical care recipients may elicit physicians’ negative emotions and influence their clinical decision making. This study investigated the impact of the psychiatric or social background of such patients on physicians’ decision making about whether to offer recommendations for further examinations and whether they expressed an appropriate disposition toward the patient.MethodsA randomized, controlled multi-centre study of residents in transitional, internal medicine, or emergency medicine was conducted in five hospitals. Upon randomization, participants were stratified by gender and postgraduate year, and they were allocated to scenario set 1 or 2. They answered questions pertaining to decision-making based on eight clinical vignettes. Half of the eight vignettes presented to scenario set 1 included additional patient information, such as that the patient had a past medical history of schizophrenia or that the patient was a recipient of free care who made frequent visits to the doctor (biased vignettes). The other half included no additional information (neutral vignettes). For scenario set 2, the four biased vignettes presented to scenario set 1 were neutralized, and the four neutral vignettes were rendered biased by providing additional information. After reading, participants answered decision-making questions regarding diagnostic examination, interventions, or patient disposition. The primary analysis was a repeated-measures ANOVA on the mean management accuracy score, with patient background information as a within-subject factor (no bias, free care recipients, or history of schizophrenia).ResultsA total of 207 questionnaires were collected. Repeated-measures ANOVA showed that additional background information had influence on mean accuracy score (F(7, 206) = 13.84, p < 0.001 partial η2 = 0.063). Post hoc pairwise multiple comparison test, Sidak test, showed a significant difference between schizophrenia and no bias condition (p < 0.05). The ratings for patient likability were lower in the biased vignettes compared to the neutral vignettes, which was associated with the lower utilization of medical resources by the physicians.ConclusionsAdditional background information on past medical history of schizophrenia increased physicians’ mistakes in decision making. Patients’ psychiatric backgrounds should not bias physicians’ decision-making. Based on these findings, physicians are recommended to avoid being influenced by medically unrelated information.

Mental health bias in physical care: An integrative review of the literature

“…Reflecting the international nature of the issue, included empirical studies originate from multiple countries and territories. Research comes from Australia (Ewart et al, 2016; Happell et al, 2016), Canada (Lowry et al, 2021), Japan (Yamauchi et al, 2019), the Netherlands (Bennebroek Evertsz' et al, 2020), Norway (Holm et al, 2014), Puerto Rico (Rivera‐Segarra et al, 2019), Spain (Martínez‐Martínez et al, 2021), Sweden (Fernholm et al, 2020), the United Kingdom (Chuttoo & Chuttoo, 2019; Nash, 2014; Noblett et al, 2017; Shefer et al, 2014, 2015; van Nieuwenhuizen et al, 2013) and the United States (Cabassa et al, 2014; Emmanuel et al, 2021; Geiss et al, 2018; Portier et al, 2017; Reeves et al, 2010a, 2010b). As is noted in a discussion of review limitations, the sample's geographic distribution is likely not representative of the scope of research on the issue due to exclusion of non‐English language publications.…”

“…The stigmatization of individuals with mental illness occurs throughout societies, influencing the health professionals within them (Chuttoo & Chuttoo, 2019; Rivera‐Segarra et al, 2019). Further, stigma is identified as a key factor behind misdiagnosis of physical issues as psychosomatic in nature (Cabassa et al, 2014; Ho et al, 2022; Holm et al, 2014; Knaak et al, 2017; Lawson, 2018; Nash, 2014; Noblett et al, 2017; Reeves et al, 2010a, 2010b; Rivera‐Segarra et al, 2019; Shefer et al, 2014; van Nieuwenhuizen et al, 2013; Yamauchi et al, 2019). Individuals with mental illness may avoid seeking needed care due to fear of stigma from care providers (Bennebroek Evertsz' et al, 2020; Ewart et al, 2016; Happell et al, 2016; Holm et al, 2014; Martínez‐Martínez et al, 2021).…”

“…For good reason, concealment from both participants and researchers did not occur in either randomized controlled trial. The clinical vignette‐based randomized study (Yamauchi et al, 2019) did conceal some information from participants, but this research presented participants with theoretical scenarios, reducing the chance of extenuating harm.…”

How Human Decision-making Biases Influence Health Outcomes in Patient Care

“…The research also found that medical students tend to physically touch patients with a low socioeconomic status more frequently. A recent study by Yamauchi et al (2019) investigating in the psychiatric and social background of patients found significant differences in clinical decision-making by physicians when patients had a medical history of schizophrenia.…”

Frequency of Difficult Patient Encounters in a Japanese University Hospital and Community Hospitals: A Cross-sectional Study

“…Furthermore, the number of visits to medical facilities tends to in-crease in patients involved with DPEs (7), which can affect the cost of medical care (7). Furthermore, DPEs are associated with diagnostic errors (8)(9)(10). Thus, DPEs have a significant detrimental impact on not only physicians but also the patients themselves and healthcare economics (3).…”