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Purpose: Despite having formal diagnostic criteria, psychiatric diagnoses can still be subjective, permitting non-psychiatric considerations, such as biases and stereotypes, to impact diagnostic decisions. This is especially problematic, since these decisions significantly influence immediate treatment, and may have long-term consequences on the course of the problem or illness. This study investigated whether workload and busyness influence psychiatric diagnosis and disposition decision-making in an emergency room setting.
Methods: Patterns of decisionmaking were examined through retrospective review of records of 1300 psychiatric patients, treated by 75 clinicians in an urban Psychiatric Emergency Service in the Mid-west, along with interviews of a random sample of these clinicians. Patient records were randomly sampled, according to the clinician’s level of cognitive load, based on the average number of patients typically seen during that shift and the actual volume of patients seen by the particular clinician during that shift. Cognitive load is the magnitude of demands imposed within specific time constraints and other limitations that restrict the amount of available cognitive resources to be dedicated to some task.
Results: Multinomial logistic regression analyses revealed that beyond clinical symptoms, nonpsychiatric factors such as race, gender, and cognitive load influence PES diagnostic and disposition decisionmaking. For example, when clinicians are under heavy load, they are significantly less likely (p<.04) to assign a bipolar diagnosis than a psychotic diagnosis. In addition, Black patients were significantly less likely (p<.001) to receive a bipolar diagnosis than a psychotic diagnosis, when compared to White patients. Furthermore, male patients were significantly less likely (p<.026) to receive a bipolar diagnosis than a psychotic diagnosis, when compared to female patients. Additional analyses revealed other clinician and patient characteristics that significantly influence PES decisionmaking.
Conclusions: When clinicians are loaded down and busy, bias and stereotypes are more likely to influence their decisions, affecting specific sub-groups more than others. This could lead to misdiagnosis and/or inappropriate clinical decisions, which could have negative long-term effects on patients. These findings support the need for further evaluation and examination of these factors in order to help guide healthcare policy aimed to protect specific subgroups of client populations, which is critical to the delivery of quality mental health care.
See more of Poster Session - Utility Theory; Health Economics; Patient & Physician Preferences; Simulation; Technology Assessment
See more of The 26th Annual Meeting of the Society for Medical Decision Making (October 17-20, 2004)