Course Level: Intermediate
Format Requirements: The course faculty will present information using lectures and handouts, and there will be individual, small group, and full class activities. Psychological phenomena that may produce inaccurate diagnoses will be illustrated using diagnostic case exercises and the results of psychological studies. To understand how diagnostic judgments may be inaccurate, the course will refer to prescriptive principles for selecting and utilizing information. For participant convenience, we will provide computer aids and reference sheets that illustrate the relevant norms, covering the application of Bayes' theorem to clinical information, the assessment of potential information for usefulness in reducing diagnostic uncertainty, and the calculation of treat/test/no-treat threshold probabilities for individual items of diagnostic information. Consideration of the processes of physician behavior revealed by psychological studies and theories makes clear the gap that needs to be bridged to improve clinical diagnosis. There will be ample opportunity to discuss the implications of the material.
Background: Psychological science has an important role to play in supporting physician diagnosis. While prescriptions for optimal diagnostic strategies and tools to aid diagnosis have been developed, still diagnostic errors are common. Misdiagnosis has been attributed to physicians’ inadequate clinical diagnosis skills, to poorly designed clinical information environments and workflow, and to time stress and information overload. The course will present psychology’s insights regarding physicians’ understanding of the principles of optimal diagnostic reasoning and their cognitive strategies for applying those principles in practice. We'll describe the ways practitioners have been observed to hypothesize and reason diagnostically, and highlight ways this be suboptimal. We'll give participants the opportunity to apply some unfamiliar concepts useful in diagnosis and reflect on why it is difficult to use them. We’ll review research on training clinicians to fully utilize clinical information for diagnosis, and discuss why these efforts have produced mixed results.
Description and Objectives: This intermediate level course on the psychology of medical diagnosis reviews the role of psychology in promoting good diagnostic performance. Our starting point must be the principles of optimal hypothesis generation and information gathering and use. How well do clinicians understand and use these principles? Must they understand them in order to diagnose accurately? We'll cover these aspects of the psychology of clinicians’ diagnostic performance:
* hypothesis generation
* selection of useful questions regarding the cause of the patient’s complaint,
* adjustment of diagnoses’ probabilities,
* decision to act on a diagnosis or diagnoses,
* conscious deliberation and automatic recognition (multiple processes).
Understanding good diagnostic performance requires understanding the nature of the diagnostic task and the best way to use information, as well describing how clinicians do these tasks and measuring their shortcomings. Attendees will be shown the normative rules (for categorizing based on symptom diagnosticity, for updating probabilities with Bayes’ theorem, for deriving test thresholds or action thresholds based on the utility of missing a diagnosis or unnecessarily treating for it, and for selecting the most useful information to seek). Description of physician diagnosis starts with recognition that our limited cognitive capacity necessitates use of heuristic strategies rather than exact calculation (e.g., hypothesis generation (activation, recognition); probability estimation (availability); probability updating (by similarity rather than prevalence and diagnosticity); information search (premature closure; information distortion, confirmation bias, pseudodiagnosticity, subadditivity)). Clinician skill is supported by the human capability of developing expert habits (skills, scripts) and by multiple capabilities and strategies (dual processes, management of strategy and effort, reflection) which enable flexible compensation for one’s limited computational abilities. Research methods for characterizing what clinicians do will be reviewed.