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首页> 外文期刊>Sociology of health & illness >What happens along the diagnostic pathway to CHD treatment? Qualitative results concerning cognitive processes.
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What happens along the diagnostic pathway to CHD treatment? Qualitative results concerning cognitive processes.

机译：冠心病治疗的诊断途径会发生什么？有关认知过程的定性结果。

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摘要

Extensive research on health disparities documents persistent differential diagnosis and treatment of many conditions according to patient characteristics, physician attributes, and healthcare systems. Less is known about how physicians arrive at their decisions. We use qualitative data from a vignette-based factorial experiment to examine how physicians reason through and account for their clinical decisions, and how variations arise despite the presentation of identical symptoms of coronary heart disease (CHD). We find that physicians show evidence of cognitive biases but also actively interpret social characteristics they deem relevant to medical treatment. In an uncertain clinical context, these diagnostic pathways expose key junctures wherein physicians are detoured to alternative diagnoses, their certainty of CHD lowered, and scientific logic makes it difficult to return to a CHD diagnosis - thereby providing a fuller picture of why some cases are counted as CHD while others are not. These results have important implications insofar as diagnostic decisions like these contribute to the compilation of epidemiologic base rates, and are therefore used as part of Bayesian decision making to determine the probability of CHD in subsequent patients. This work resonates with social constructivist concerns regarding the ways disease categories are established and maintained, and potential sources of bias in official rates detected.
机译：关于健康差异的广泛研究表明，根据患者特征，医师属性和医疗保健系统，对许多疾病进行持续的差异诊断和治疗。对医生如何做出决定的了解还很少。我们使用来自基于小插图的析因实验的定性数据来检查医生如何做出推理并考虑他们的临床决定，以及尽管呈现出相同的冠心病（CHD）症状，但变异如何产生。我们发现医师显示出认知偏见的证据，但也积极地解释了他们认为与治疗有关的社会特征。在不确定的临床环境中，这些诊断途径暴露了关键时刻，其中医师们绕过了其他诊断方法，降低了冠心病的确定性，科学逻辑使得难以返回冠心病诊断-从而提供了为什么某些病例被计数的更全面的图景作为冠心病，而其他人则不然。这些结果对此类诊断决策有助于流行病学基础率的编制具有重要意义，因此，它们被用作贝叶斯决策的一部分，以确定后续患者中冠心病的可能性。这项工作引起了社会建构主义者对疾病类别的建立和维护方式的关注，并发现了官方发病率存在偏见的潜在原因。

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