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L D Gruppen

Publications and source records attributed to L D Gruppen.

43 records · Page 3Linked to original sources

Information-seeking strategies and differences among primary care physicians.

Differences in the sources of information that physicians utilize in their practice have several implications for the quality of care delivered and the dissemination of medical information. In order to examine the extent of differences in information preferences in primary care settings, 98 general internal medicine physicians and 73 family physicians were asked to indicate which of six alternative information sources they relied on most when faced with difficult medical problems. The alternatives were: journals, textbooks, informal consultations with colleagues, consultations with community specialists, consultations with outside specialists, and transfer of the patient to another physician. The results indicated that primary care internists have a greater preference for consulting the medical literature, while family physicians more often rely on colleagues and specialists as sources of information. These differences suggest that the focus of information dissemination through journals or textbooks may be more effective for internists, while colleagues or "educationally influential" physicians in the community may be more effective vehicles for information dissemination to family physicians.

Choice Behavior↗

Differential diagnosis and the competing-hypotheses heuristic. A practical approach to judgment under uncertainty and Bayesian probability.

Evaluating the same diagnostic information across the plausible competing diagnoses is a practical strategy (ie, heuristic) to guide decision making in the face of uncertainty. The prevalence of use of this competing-hypotheses heuristic by 89 first-year house officers was examined in three simulated patient cases. Results indicated that only a minority (24%) of the house officers selected optimal diagnostic information consistent with this Bayesian heuristic across all three cases. Almost all (97%) of the house officers selecting optimal diagnostic information were able to identify the most probable diagnosis specified by Bayes' theorem, while only a chance number (53%) of house officers selecting nonoptimal information were able to identify the most probable diagnosis. The competing-hypotheses heuristic is discussed within the context of diagnostic problem-solving models derived from the literature on medical decision making and clinicopathological conference case records. It is suggested that the heuristic, which does not necessitate any mathematical calculations, may be useful as a complement to clinical judgment.

Bayes Theorem↗

Information gathering and integration as sources of error in diagnostic decision making.

This research examined the relative importance of information gathering versus information utilization in accounting for errors in diagnostic decision making. Two experiments compared physicians' performances under two conditions: one in which they gathered a limited amount of diagnostic information and then integrated it before making a decision, and the other in which they were given all the diagnostic information and needed only to integrate it. The physicians: 1) frequently failed to select normatively optimal information in both experimental conditions; 2) were more confident about the correctness of their information selection when their task was limited to information integration than when it also included information gathering; and 3) made diagnoses in substantial agreement with those indicated by applying normative procedures to the same data. Physicians appear to have difficulties recognizing the diagnosticity of information, which often results in decisions that are pseudodiagnostic or based on diagnostically worthless information.

Bayes Theorem↗