title: Different answers to different questions: exploring clinical decision making by general practitioners and psychiatrists about depressed patients.
abstract: OBJECTIVE
  Exploring three perspectives on differences between general practitioners (GP) and psychiatrists in clinical decision making about depressed patients. The gold standard perspective focuses on differences in decisions (output) as a result of lack of expertise, the input perspective relates differences to different information use and to other roles, and the throughput perspective attributes differences to other information processing.
  
  
  METHODS
  Twenty-six psychiatrists and 25 GPs gave their clinical judgment on four on-line vignettes of increasingly severely depressed patients. Supplementary information on 15 themes could be asked for by clicking on underlined phrases. Dependent variables were the amount and type of extra information used, time needed and judgments of the severity of symptoms, appropriate treatment and health care providers.
  
  
  RESULTS
  Compared to psychiatrists, GPs were more reluctant to refer to specialized care, they needed less supplementary information and reached their conclusion in less time. Their processing of information appeared to be more contextual. Psychiatrists used a more stable procedure in which information inspection took place independently of differences in the vignettes.
  
  
  CONCLUSIONS
  GPs and psychiatrists not only give different answers (treatment advices) because they have different expertise, but also because they have different questions due to other roles, and they use different clinical decision procedures. Insight in these differences can be useful for ameliorating collaborative mental health care.
authors.affiliation: BSI: Behavioural Science Institute. Radboud University Nijmegen, The Netherlands; ProCES: Pro Persona Centre for Education and Science, Wolfheze, The Netherlands. Electronic address: g.hutschemaekers@psych.ru.nl.
authors.forename: Giel J M
authors.initials: GJ
authors.lastname: Hutschemaekers
authors.affiliation: BSI: Behavioural Science Institute. Radboud University Nijmegen, The Netherlands.
authors.forename: Cilia L M
authors.initials: CL
authors.lastname: Witteman
authors.affiliation: ProCES: Pro Persona Centre for Education and Science, Wolfheze, The Netherlands.
authors.forename: Judith
authors.initials: J
authors.lastname: Rutjes
authors.affiliation: Department of Psychology, Catholic University of Leuven, Belgium.
authors.forename: Laurence
authors.initials: L
authors.lastname: Claes
authors.affiliation: Umc Sint Radboud: Centre for Primary Care Radboud University Nijmegen, The Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: Lucassen
authors.affiliation: ProCES: Pro Persona Centre for Education and Science, Wolfheze, The Netherlands.
authors.forename: Ad
authors.initials: A
authors.lastname: Kaasenbrood
mesh_terms: D000328:Adult; D003657:Decision Making; D003863:Depression / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D058005:General Practitioners / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011570:Psychiatry / Q000592:standards*
keywords: Clinical decision making; Depression; Mental health care; Primary care; Psychiatry