Predictors of diagnostic accuracy and safe management in difficult diagnostic problems in family medicine.

Objective: To investigate the role of information gathering and clinical experience on the diagnosis and management of difficult diagnostic problems in family medicine.

Method: Seven diagnostic scenarios including 1 to 4 predetermined features of difficulty were constructed and presented on a computer to 84 physicians: 21 residents in family medicine, 21 family physicians with 1 to 3 y in practice, and 42 family physicians with >or=10 y in practice. Following the Active Information Search process tracing approach, participants were initially presented with a patient description and presenting complaint and were subsequently able to request further information to diagnose and manage the patient.

Judgment analysis: a method for quantitative evaluation of trainee surgeons' judgments of surgical risk.

Background: Surgical judgment and decision making require valid methods of assessment. The aim of this study was to evaluate the use of judgment analysis as a technique for quantitative evaluation of surgeons' risk estimates.

Methods: Thirty trainee surgeons' estimates of conversion risk in laparoscopic cholecystectomy were investigated using judgment analysis.

Which doctors are influenced by a patient's age? A multi-method study of angina treatment in general practice, cardiology and gerontology.

Background: Elderly patients with cardiovascular disease are relatively undertreated and undertested.

Objectives: To investigate whether, and how, individual doctors are influenced by a patient's age in their investigation and treatment of angina.

Design: Process-based judgment analysis using electronic patients, semistructured interviews.

Evaluating psychodiagnostic decisions.

Rationale: Several frameworks can be used to evaluate decision making. These may relate to different aspects of the decision-making process, or concern the decision outcome. Evaluations of psychodiagnostic decisions have shown diagnosticians to be poor decision makers.

Variations in cardiac interventions: doctors' practices and views.

Objectives: To investigate referral rates for cardiac interventions by clinical specialty, to document doctors' reasons for referrals and to explore doctors' perceptions of the factors that influenced their clinical decisions.

Study Design: Doctors completed a clinical decision-making exercise involving, in total, 6093 electronic patients with cardiac disease, and subsequently took part in the semi-structured interviews about influences on their decisions. Interviews were audio-recorded, transcribed and coded using a thematic approach, with the coding categories derived from the data.

Participant recruitment methods and statistical reasoning performance.

Optimal Bayesian reasoning performance has reportedly been elusive, and a variety of explanations have been suggested for this situation. In a series of experiments, it is demonstrated that these difficulties with replication can be accounted for by differences in participant-sampling methodologies. Specifically, the best performances are obtained with students from top-tier, national universities who were paid for their participation.

Making decisions about benefits and harms of medicines.

Even when good scientific data are available, people's interpretation of risks and benefits will differ

Patients with right frontal lesions are unable to assess and use advice to make predictive judgments.

Frontal lobe damage impairs decision-making. Most studies have employed gambling and probabilistic tasks, which have an emotional (reward-punishment) component and found that patients with ventromedial sector lesions have exceptional difficulty performing normally on these tasks. We have recently presented an economic decision-making task to patients and normal volunteers that required them to not only forecast an economic outcome but also to weigh advice from four advisors about the possible outcome across 40 trials.