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On the use of positive test strategies when diagnosing mental disorders
Van Der Heijden,Paul T. Cefo,Irma Witteman,Cilia L.m. Grootens,Koen P.
Van Der Heijden,Paul T.
Cefo,Irma
Witteman,Cilia L.m.
Grootens,Koen P.
Abstract
Background Despite the adverse impact diagnostic errors can have, clinical interviewing and decision-making in psychiatric practice have received relatively little empirical attention. When diagnosing patients, clinicians tend to fall back on a specific (heuristic) rule of thumb, the positive test strategy, a confirmatory approach that increases the risk of confirmation bias. Method and results A group of 83 clinical psychologists and psychiatrists was asked to give their diagnostic hypotheses about two vignettes. We found them to self-generate significantly (i.e., p < .01; d = 1.57) more confirming than disconfirming questions to test their initial diagnostic impressions, with supervisors considering significantly more differential diagnoses than the less experienced post-grads/residents. When offered a list of 100 potentially relevant diagnostic queries, the supervisors selected fewer confirming and proportionally more disconfirming themes. Conclusions Our results demonstrate that irrespective of clinical experience mental-health clinicians indeed tend to use a confirmatory thinking style that contrasts with the stricter principle of falsification. More field-based research on this topic is needed, as well as studies probing whether a systematized diagnostic approach is feasible in psychiatric practice and increases diagnostic accuracy and patient satisfaction.
Description
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Date
2022
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Publisher
Research Projects
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Keywords
Bias, CLINICAL JUDGMENT, Confirmation bias, DECISION-MAKING, Decision making, Heuristics, PSYCHIATRISTS, Positive test strategy, Psychiatric diagnosis
Citation
Van Der Heijden, P T, Cefo, I, Witteman, C L M & Grootens, K P 2022, 'On the use of positive test strategies when diagnosing mental disorders', Comprehensive Psychiatry, vol. 116, 152325. https://doi.org/10.1016/j.comppsych.2022.152325