PSYC 4320 Lecture Notes - Lecture 4: Coronary Artery Disease, Factorial Experiment, Structured Interview

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28 Jul 2016
DISCUSSION 4 - January 26
1. What methods are used in Welch et al. (2012)’s study? What are the main results for the
quantitative data and for the qualitative data? This particular combination of methods is a bit
unusual. What do you think about the final conclusions? Do you think that both studies are needed
to make their final arguments? Why or why not?
Study: Examine how physicians' interpretations of patient sex-gender affect diagnostic certainty and, in
turn, decision making for coronary heart disease
a) Methods: Mixed-method vignette-based experimental design
A factorial experiment of 256 physicians who viewed I of 16 video vignettes with different patient-actors
presenting the same symptoms of coronary heart disease, with the same words and hand gestures
After viewing video, physicians provided their diagnosis, certainty for each diagnosis on scale of 0-100
and management plan
Physicians completed a structured interview and provided a narrative about their decision-making process
Diagnostic uncertainty reduces the likelihood that physicians will order tests and medications appropriate
for an urgent cardiac condition in particular
Not much of a difference here between male and female ‘patients’
Qualitative: Physicians interpreted the same symptom presentation (same script, same gestures)
differently for men and women
The effort to incorporate women in the knowledge base yielded the belief that women more often than
men have "atypical symptoms”
For men, sex-gender and age = risk factor
For women, sex-gender was more salient for physician interpretations (especially for middle-aged
women) → led to interpreting symptoms as ‘atypical’
Physicians’ decision making process was longer (more exploratory) for female patients due to their
attempts to “rule out” the most life threatening possibility
For those physicians who focused on cardiac disease in women first more often were diagnosing women
over men
*mediation affect – mediated by certainty of symptoms
Language- being called “atypical symptoms” when it’s really just the typical symptoms of women
b) Reactions to Final Conclusions:
Interesting thought: symptoms are not static stimuli but rather are actively interpreted by a provider
Double-edge sword:
Some physicians who generalized atypical symptoms used this generalization to look at CHD
aggressively, while others used generalization to justify other possibilities in their treatment
Interesting to see if these symptoms are showing up more in men, maybe gaining the title of “atypical”
(Lecture 3a: it seems that men report ‘atypical’ symptoms as well)
The notion that symptoms in women, in this one group is a starting point for studying men
c) Are both studies needed? Yes:
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