1. Gendered uncertainty and variation in physicians' decisions for coronary heart disease: the double-edged sword of "atypical symptoms".
- Author
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Welch LC, Lutfey KE, Gerstenberger E, and Grace M
- Subjects
- Aged, Attitude of Health Personnel, Communication, Decision Making, Female, Humans, Male, Middle Aged, Patient Selection, Patient Simulation, Physician-Patient Relations, Sex Factors, Stereotyping, Videotape Recording, Coronary Disease diagnosis, Practice Patterns, Physicians', Uncertainty
- Abstract
Nonmedical factors and diagnostic certainty contribute to variation in clinical decision making, but the process by which this occurs remains unclear. We examine how physicians' interpretations of patient sex-gender affect diagnostic certainty and, in turn, decision making for coronary heart disease. Data are from a factorial experiment of 256 physicians who viewed 1 of 16 video vignettes with different patient-actors presenting the same symptoms of coronary heart disease. Physician participants completed a structured interview and provided a narrative about their decision-making processes. Quantitative analysis showed that diagnostic uncertainty reduces the likelihood that physicians will order tests and medications appropriate for an urgent cardiac condition in particular. Qualitative analysis revealed that a subset of physicians applied knowledge that women have "atypical symptoms" as a generalization, which engendered uncertainty for some. Findings are discussed in relation to social-psychological processes that underlie clinical decision making and the social framing of medical knowledge.
- Published
- 2012
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