title: Gendered uncertainty and variation in physicians' decisions for coronary heart disease: the double-edged sword of "atypical symptoms".
abstract: Nonmedical factors and diagnostic certainty contribute to variation in clinical decision making, but the process by which this occurs remains unclear. We examine how physicians' interpretations of patient sex-gender affect diagnostic certainty and, in turn, decision making for coronary heart disease. Data are from a factorial experiment of 256 physicians who viewed 1 of 16 video vignettes with different patient-actors presenting the same symptoms of coronary heart disease. Physician participants completed a structured interview and provided a narrative about their decision-making processes. Quantitative analysis showed that diagnostic uncertainty reduces the likelihood that physicians will order tests and medications appropriate for an urgent cardiac condition in particular. Qualitative analysis revealed that a subset of physicians applied knowledge that women have "atypical symptoms" as a generalization, which engendered uncertainty for some. Findings are discussed in relation to social-psychological processes that underlie clinical decision making and the social framing of medical knowledge.
authors.affiliation: New England Research Institutes, Watertown, MA 02472, USA. lwelch@neriscience.com
authors.forename: Lisa C
authors.initials: LC
authors.lastname: Welch
authors.forename: Karen E
authors.initials: KE
authors.lastname: Lutfey
authors.forename: Eric
authors.initials: E
authors.lastname: Gerstenberger
authors.forename: Matthew
authors.initials: M
authors.lastname: Grace
mesh_terms: D000368:Aged; D001291:Attitude of Health Personnel; D003142:Communication; D003327:Coronary Disease / Q000175:diagnosis*; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D016544:Patient Simulation; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D012737:Sex Factors; D013240:Stereotyping; D035501:Uncertainty; D014743:Videotape Recording