The Phenomenology of the Diagnostic Process: A Primary Care-Based Survey.
While dichotomous tasks and related cognitive strategies have been extensively researched in cognitive psychology, little is known about how primary care practitioners (general practitioners [GPs]) approach ill-defined or polychotomous tasks and how valid or useful their strategies are.



To investigate cognitive strategies used by GPs for making a diagnosis.



In a cross-sectional study, we videotaped 282 consultations, irrespective of presenting complaint or final diagnosis. Reflective interviews were performed with GPs after each consultation. Recordings of consultations and GP interviews were transcribed verbatim and analyzed using a coding system that was based on published literature and systematically checked for reliability.



In total, 134 consultations included 163 diagnostic episodes. Inductive foraging (i.e., the initial, patient-guided search) could be identified in 91% of consultations. It contributed an average 31% of cues obtained by the GP in 1 consultation. Triggered routines and descriptive questions occurred in 38% and 84% of consultations, respectively. GPs resorted to hypothesis testing, the hallmark of the hypothetico-deductive method, in only 39% of consultations.



Video recordings and interviews presumably interfered with GPs' behavior and accounts. GPs might have pursued more hypotheses and collected more information than usual.



The testing of specific disease hypotheses seems to play a lesser role than previously thought. Our data from real consultations suggest that GPs organize their search for information in a skillfully adapted way. Inductive foraging, triggered routines, descriptive questions, and hypotheses testing are essential building blocks to make a diagnosis in the generalist setting.
Department of Primary Care, Philipps University of Marburg, Marburg, Germany (ND-B, JS, AMS, SB, MV).
Norbert
N
Donner-Banzhoff
Department of Primary Care, Philipps University of Marburg, Marburg, Germany (ND-B, JS, AMS, SB, MV).
Judith
J
Seidel
Department of Primary Care, Philipps University of Marburg, Marburg, Germany (ND-B, JS, AMS, SB, MV).
Anna Maria
AM
Sikeler
Department of Primary Care, Philipps University of Marburg, Marburg, Germany (ND-B, JS, AMS, SB, MV).
Stefan
S
Bösner
Department of Primary Care, Philipps University of Marburg, Marburg, Germany (ND-B, JS, AMS, SB, MV).
Maria
M
Vogelmeier
Harding Center for Risk Literacy, Max-Planck-Institute for Human Development, Berlin, Germany (AW, MF, OW, GG).
Anja
A
Westram
Harding Center for Risk Literacy, Max-Planck-Institute for Human Development, Berlin, Germany (AW, MF, OW, GG).
Markus
M
Feufel
Department of Psychology, University of Konstanz, Konstanz, Germany (WG).
Wolfgang
W
Gaissmaier
Harding Center for Risk Literacy, Max-Planck-Institute for Human Development, Berlin, Germany (AW, MF, OW, GG).
Odette
O
Wegwarth
Harding Center for Risk Literacy, Max-Planck-Institute for Human Development, Berlin, Germany (AW, MF, OW, GG).
Gerd
G
Gigerenzer
D000066491:Clinical Decision-Making / Q000379:methods*; D003430:Cross-Sectional Studies; D005260:Female; D058005:General Practitioners / Q000523:psychology*; D005858:Germany; D006801:Humans; D057226:Information Seeking Behavior; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D013850:Thinking; D013997:Time Factors
cues; decision making; diagnosis, family medicine; general practice; hypothesis testing; qualitative research