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. 2009 Mar;89(3):279-87.
doi: 10.1016/j.healthpol.2008.06.007. Epub 2008 Aug 12.

Is certainty more important than diagnosis for understanding race and gender disparities?: an experiment using coronary heart disease and depression case vignettes

Karen E Lutfey  1 , Carol L Link, Richard W Grant, Lisa D Marceau, John B McKinlay
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Is certainty more important than diagnosis for understanding race and gender disparities?: an experiment using coronary heart disease and depression case vignettes

Karen E Lutfey et al. Health Policy. .
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Abstract

Objectives: To (1) examine the influence of patient and provider attributes on physicians' diagnostic certainty and (2) assess the effect of diagnostic certainty on clinical therapeutic actions.

Methods: Factorial experiment of 128 generalist physicians using identical clinically authentic videotaped vignettes depicting patients with coronary heart disease (CHD) or depression.

Results: For CHD, physicians were least certain for Black patients (p=.003) and for younger female patients (p=.013). For depression, average certainty was higher than for the CHD presentation (74.0 vs. 57.9 on of scale of 0-100, p<.001 and there were no main effects of patient or provider characteristics. increasing diagnostic certainty was a significant predictor subsequent clinical actions these varied according to physician characteristics across both conditions.>

Conclusions: Physicians were least certain of their CHD diagnoses for Black patients and for younger women, but patient characteristics alone did not affect physician certainty of depression diagnoses. Physicians responded differentially to diagnostic certainty in terms of their clinical therapeutic actions such as test ordering and writing prescriptions. Physician responses to certainty may be as important as their responses to patient characteristics for understanding variation in clinical decision-making.

Conflict of interest statement

There were no conflicts of interest.

Figures

Figure 1. Physician certainty of CHD and Depression diagnoses (p < .0001)
Certainty ranges from 0 (complete uncertainty) to 100 (complete certainty). The box and whiskers plot can be interpreted as follows: the whiskers extend to the data minimum and maximum, the bottom of the box is at the 25th percentile, the top of the box is at the 75th percentile, the middle line is the median, and the + is at the mean.
Figure 2
Figure 2a: Two-way interaction effect of patient gender and patient age on physicians’ certainty (0–100) of a CHD diagnosis (p = .013). Figure 2b: Two-way interaction effect of physician gender and diagnostic certainty on number of CHD tests ordered (p = .0125). Figure 2c: Two-way interaction effect of patient SES and physician gender on physicians’ certainty (0–100) of a depression diagnosis (p = .0103).
Figure 2
Figure 2a: Two-way interaction effect of patient gender and patient age on physicians’ certainty (0–100) of a CHD diagnosis (p = .013). Figure 2b: Two-way interaction effect of physician gender and diagnostic certainty on number of CHD tests ordered (p = .0125). Figure 2c: Two-way interaction effect of patient SES and physician gender on physicians’ certainty (0–100) of a depression diagnosis (p = .0103).
Figure 2
Figure 2a: Two-way interaction effect of patient gender and patient age on physicians’ certainty (0–100) of a CHD diagnosis (p = .013). Figure 2b: Two-way interaction effect of physician gender and diagnostic certainty on number of CHD tests ordered (p = .0125). Figure 2c: Two-way interaction effect of patient SES and physician gender on physicians’ certainty (0–100) of a depression diagnosis (p = .0103).
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