Factors that influence General Practitioner diagnostic decision-making and a comparison with other stakeholders

Abstract

Abstract

Background

An analysis of Accident Compensation Corporation claims shows “inconsistent and inadequate diagnoses” by health care providers. Diagnostic performance is a result of two independent parameters, namely discrimination (accuracy) and decision (bias). Bias is related to the medical practitioner’s perception of the costs and benefits of making one choice over another. Bias may be statistical, sociological, political, biological or psychological in nature. This study investigated the factors that potentially bias diagnostic decision-making by general practitioners and the subjective value placed on these factors by different stakeholder groups in society. Methods

Phase 1 of the study used focus groups of standard setters for general practitioners to identify factors that influenced diagnostic decision-making in general practice. These factors were evaluated for importance and desirability using standard Delphi methodology and Rasch analysis. Phase 2 of the study evaluated the importance and desirability of the factors identified in Phase 1 for influencing decision making as judged by significant health care stakeholder groups in New Zealand. Participant response was via questionnaire analysed by the Rasch Model. Results

Thirty-nine factors were identified that potentially biased diagnostic decision-making in general practice. The measurements of, particularly, desirability have high reproducibility across stakeholder groups and high positive loading for the first principal component consistent with construct validity. No stakeholder group identifies factors consistent with Bayes’ theorem of diagnostic reasoning as being the only desirable influence on diagnosis. There is considerable categorical homogeneity between the stakeholder groups GP, GPACC, P, RACCSLT and RACCSST. Conclusions

The findings of this and other studies challenge the current biomedical paradigm, indicating a less than Bayesian approach to medical decision-making. A social constructivist model, incorporating non-Bayesian factors into the definition of “illness” versus “disease”, may be more representative of reality. A social constructivist model of medicine is incompatible with the current legislatory and administrative framework within which the Accident Compensation Corporation and a number of other medical organisations operate.