Non-medical influences on medical decision-making

McKinlay, John B.; Potter, Deborah; Feldman, Henry A.

doi:10.1016/0277-9536(95)00342-8

Cited by 195 publications

(153 citation statements)

References 43 publications

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“…Given these costs, effective management of ADHD is a significant health policy goal (8); however this requires accurate, reliable and valid diagnosis of the condition and the use of appropriate and proven treatment options. When making decisions to diagnose or treat patients, the literature suggests that clinicians are influenced by both clinical and nonclinical factors such as the potential cost of treatment and the patient's social-economic status (9)(10)(11)(12).…”

mentioning

confidence: 99%

The decisions regarding ADHD management (DRAMa) study: uncertainties and complexities in assessment, diagnosis and treatment, from the clinician’s point of view

Kovshoff

Williams

Vrijens

et al. 2011

Eur Child Adolesc Psychiatry

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mentioning

confidence: 99%

The decisions regarding ADHD management (DRAMa) study: uncertainties and complexities in assessment, diagnosis and treatment, from the clinician’s point of view

Kovshoff

Williams

Vrijens

et al. 2011

Eur Child Adolesc Psychiatry

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“…49 However, even "evidence-based" stereotypes are likely to contribute to disparities when providers fail to correctly incorporate individual data, and instead are swayed by their beliefs regarding the probabilities of individuals in a sociodemographic category having a given characteristic. 50 5) Providers, like all humans, may be more likely to rely on stereotypes for "outgroup members. "…”

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confidence: 99%

Why do providers contribute to disparities and what can be done about it?

2004

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This paper applies social cognition research to understanding and ameliorating the provider contribution to racial/ethnic disparities in health care. We discuss how fundamental cognitive mechanisms such as automatic, unconscious processes (e.g., stereotyping) can help explain provider bias. Even wellintentioned providers who are motivated to be nonprejudiced may stereotype racial/ethnic minority members, particularly under conditions of that diminish cognitive capacity. These conditions -time pressure, fatigue, and information overloadare frequently found in health care settings. We conclude with implications of the social-cognitive perspective for developing interventions to reduce provider bias.

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“…1,2 In particular, research indicates that the care a patient receives may be as much a function of who the patient is (age, gender, race= ethnicity, socioeconomic status [SES]), who the provider is (age, gender, specialty), and where the care is delivered (private= public facility, geographic location) as it is of the symptoms actually present. [3][4][5][6][7][8][9][10] A compelling example is coronary heart disease (CHD), the single greatest cause of death for men and women in the United States and Europe. Remarkably, women generally have lower age-adjusted CHD incidence and mortality than men.…”

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confidence: 99%

Disparities in Physicians' Interpretations of Heart Disease Symptoms by Patient Gender: Results of a Video Vignette Factorial Experiment

Maserejian

Link

Lutfey

et al. 2009

Journal of Women's Health

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Background: Previous studies have documented the underdiagnosis of coronary heart disease (CHD) in women, but less is known about which alternate diagnoses take precedence and whether additional patient factors modify possible gender bias. Objective: To measure gender variation in clinical decision making, including (1) the number, types, and certainty levels of diagnoses considered and (2) how diagnoses vary according to patient characteristics, when patients have identical symptoms of CHD. Methods: This was a factorial experiment presenting videotaped CHD symptoms, systematically altering patient gender, age, socioeconomic status (SES) and race, and physician gender and level of experience. The primary end point was physicians' most certain diagnosis. Results: Physicians (n ¼ 128) mentioned five diagnoses on average, most commonly heart, gastrointestinal, and mental health conditions. Physicians were significantly less certain of the underlying cause of symptoms among female patients regardless of age ( p ¼ 0.006), but only among middle-aged women were they significantly less certain of the CHD diagnosis ( p < 0.001). Among middle-aged women, 31.3% received a mental health condition as the most certain diagnosis, compared with 15.6% of their male counterparts ( p ¼ 0.03). An interaction effect showed that females with high SES were most likely to receive a mental health diagnosis as the most certain ( p ¼ 0.006). Conclusions: Middle-aged female patients were diagnosed with the least confidence, whether for CHD or non-CHD conditions, indicating that their gender and age combination misled physicians, particularly toward mental health alternative diagnoses. Physicians should be aware of the potential for psychological symptoms to erroneously take a central role in the diagnosis of younger women.

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Non-medical influences on medical decision-making

Cited by 195 publications

References 43 publications

The decisions regarding ADHD management (DRAMa) study: uncertainties and complexities in assessment, diagnosis and treatment, from the clinician’s point of view

The decisions regarding ADHD management (DRAMa) study: uncertainties and complexities in assessment, diagnosis and treatment, from the clinician’s point of view

Why do providers contribute to disparities and what can be done about it?

Disparities in Physicians' Interpretations of Heart Disease Symptoms by Patient Gender: Results of a Video Vignette Factorial Experiment

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