Dataset Information

The Role of Physicians' First Impressions in the Diagnosis of Possible Cancers without Alarm Symptoms.

ABSTRACT:

Background

First impressions are thought to exert a disproportionate influence on subsequent judgments; however, their role in medical diagnosis has not been systematically studied. We aimed to elicit and measure the association between first impressions and subsequent diagnoses in common presentations with subtle indications of cancer.

Methods

Ninety UK family physicians conducted interactive simulated consultations online, while on the phone with a researcher. They saw 6 patient cases, 3 of which could be cancers. Each cancer case included 2 consultations, whereby each patient consulted again with nonimproving and some new symptoms. After reading an introduction (patient description and presenting problem), physicians could request more information, which the researcher displayed online. In 2 of the possible cancers, physicians thought aloud. Two raters coded independently the physicians' first utterances (after reading the introduction but before requesting more information) as either acknowledging the possibility of cancer or not. We measured the association of these first impressions with the final diagnoses and management decisions.

Results

The raters coded 297 verbalizations with high interrater agreement (Kappa = 0.89). When the possibility of cancer was initially verbalized, the odds of subsequently diagnosing it were on average 5 times higher (odds ratio 4.90 [95% CI 2.72 to 8.84], P < 0.001), while the odds of appropriate referral doubled (OR 1.98 [1.10 to 3.57], P = 0.002). The number of cancer-related questions physicians asked mediated the relationship between first impressions and subsequent diagnosis, explaining 29% of the total effect.

Conclusion

We measured a strong association between family physicians' first diagnostic impressions and subsequent diagnoses and decisions. We suggest that interventions to influence and support the diagnostic process should target its early stage of hypothesis generation.

SUBMITTER: Kostopoulou O

PROVIDER: S-EPMC5131625 | biostudies-literature | 2017 Jan

REPOSITORIES: biostudies-literature

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Publications

The Role of Physicians' First Impressions in the Diagnosis of Possible Cancers without Alarm Symptoms.

Kostopoulou Olga O Sirota Miroslav M Round Thomas T Samaranayaka Shyamalee S Delaney Brendan C BC

Medical decision making : an international journal of the Society for Medical Decision Making 20160425 1

<h4>Background</h4>First impressions are thought to exert a disproportionate influence on subsequent judgments; however, their role in medical diagnosis has not been systematically studied. We aimed to elicit and measure the association between first impressions and subsequent diagnoses in common presentations with subtle indications of cancer.<h4>Methods</h4>Ninety UK family physicians conducted interactive simulated consultations online, while on the phone with a researcher. They saw 6 patient ...[more]

PMID: 27112933

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Project description:Background and aimsAlthough a range of guidelines for the diagnosis and treatment of chronic constipation has been carried out, there was very little information about the understanding on constipation. The aim of the present study was to estimate the understanding of constipation symptoms and the diagnosis and management of constipation by clinical physicians in China.MethodsParticipants were physicians and researchers in the field of gastroenterology in China who were scheduled to attend the National Conference on gastrointestinal motility (Constipation). Based on the recommendation of the Rome Foundation Board, the self-reported questionnaire was constructed.FindingsAlthough most of the opinions on symptoms of constipation were consistent, there were still some differences. Opinions on the Bristol stool form during constipation were discordant, 34% of the doctors thought that it was type 1 and type 2, while 46%of the doctors suggested that type 3 should also be considered constipation. There was no significant difference between them (P = 0.05); We investigated the interpretation on the duration of defecation prolonged, 27% of the doctors suggested it should be longer than 10 minutes, 22% of the doctors suggested it should be longer than 20 minutes, and other 22% of the doctors suggested it should be time of defecation became longer compared to previously bowel habits, there was no significant difference among them (P = 0.38).Only 36% of the doctors thought that psychotherapy was most important in the treatment of severe constipation, while 37% of the doctors thought that medication treatment was most important in the treatment of severe constipation, there was no significant difference between them (P = 0.895).ConclusionWe were able to obtain valuable information about current views on symptoms of constipation and the diagnosis and treatment of constipation among Chinese doctors. Although most of the opinions were consistent there were still some differences. This study indicated that in practice in China there was a need for further study on the role of constipation symptoms and there may also be a need for better establishment of consensus guidelines for constipation.

Dataset Information

The Role of Physicians' First Impressions in the Diagnosis of Possible Cancers without Alarm Symptoms.

Background

Methods

Results

Conclusion

Publications

The Role of Physicians' First Impressions in the Diagnosis of Possible Cancers without Alarm Symptoms.

Similar Datasets

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