The phenomenology of the diagnostic process: A primary-care based survey (2017)
Authors
Abstract
BACKGROUND While dichotomous tasks and related cognitive strategies have been extensively researched in cognitive psychology, little is known about how primary care practitioners (general practitioners [GPs]) approach ill-defined or polychotomous tasks and how valid or useful their strategies are. OBJECTIVE To investigate cognitive strategies used by GPs for making a diagnosis. METHODS In a cross-sectional study, we videotaped 282 consultations, irrespective of presenting complaint or final diagnosis. Reflective interviews were performed with GPs after each consultation. Recordings of consultations and GP interviews were transcribed verbatim and analyzed using a coding system that was based on published literature and systematically checked for reliability. RESULTS In total, 134 consultations included 163 diagnostic episodes. Inductive foraging (i.e., the initial, patient-guided search) could be identified in 91% of consultations. It contributed an average 31% of cues obtained by the GP in 1 consultation. Triggered routines and descriptive questions occurred in 38% and 84% of consultations, respectively. GPs resorted to hypothesis testing, the hallmark of the hypothetico-deductive method, in only 39% of consultations. LIMITATIONS Video recordings and interviews presumably interfered with GPs' behavior and accounts. GPs might have pursued more hypotheses and collected more information than usual. CONCLUSIONS The testing of specific disease hypotheses seems to play a lesser role than previously thought. Our data from real consultations suggest that GPs organize their search for information in a skillfully adapted way. Inductive foraging, triggered routines, descriptive questions, and hypotheses testing are essential building blocks to make a diagnosis in the generalist setting.
Bibliographic entry
Donner-Banzhoff, N., Seidel, J., Sikeler, A. M., Bösner, S., Vogelmeier, M., Westram, A., Feufel, M., Gaissmaier, W., Wegwarth, O., & Gigerenzer, G. (2017). The phenomenology of the diagnostic process: A primary-care based survey. Medical Decision Making, 37, 27-34. doi:10.1177/0272989X16653401 (Full text)
Miscellaneous
| Publication year | 2017 | |
|---|---|---|
| Document type: | Article | |
| Publication status: | Published | |
| External URL: | http://dx.doi.org/10.1177/0272989X16653401 View | |
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