Clinical diagnosis and the order of information.
BACKGROUND
Information order can influence judgment. However, it remains unclear whether the order of clinical data affects physicians' interpretations of these data when they are engaged in familiar diagnostic tasks.


METHODS
Of 400 randomly selected family physicians who were given a questionnaire involving a brief written scenario about a young woman with acute dysuria, 315 (79%) returned usable responses. The physicians had been randomized into two groups, and both groups had received the same clinical information but in different orders. After learning the patient's chief complaint, physicians received either the patient's history and physical examination results followed by the laboratory data (the H&P-first group) or the laboratory data followed by the history and physical examination results (the H&P-last group). The results of the history and physical examination were supportive of the diagnosis of UTI, while the laboratory data were not. All physicians judged the probability of a urinary tract infection (UTI) after each piece of information.


RESULTS
The two groups had similar mean estimates of the probability of a UTI after learning the chief complaint (67.4% vs 67.8%, p = 0.85). At the end of the scenario, the H&P-first group judged UTI to be less likely than did the H&P-last group (50.9% vs 59.1%, p = 0.03) despite having identical information. Comparison of the mean likelihood ratios attributed to the clinical information showed that the H&P-first group gave less weight to the history and physical than did the H&P-last group (p = 0.04).


CONCLUSIONS
The order in which clinical information was presented influenced physicians' estimates of the probability of disease. The clinical history and physical examination were given more weight by physicians who received this information last.
Bergus
G R
GR
Department of Family Medicine, The University of Iowa, Iowa City 52242, USA. george-bergus@uiowa.edu
Chapman
G B
GB
Levy
B T
BT
Ely
J W
JW
Oppliger
R A
RA
D000704:Analysis of Variance; D003627:Data Interpretation, Statistical; D003933:Diagnosis; D005194:Family Practice; D005260:Female; D006801:Humans; D007600:Judgment; D016013:Likelihood Functions; D016015:Logistic Models; D008297:Male; D008487:Medical History Taking; D010808:Physical Examination; D016482:Urinalysis; D014552:Urinary Tract Infections / Q000175:diagnosis