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

Lutfey, Karen E.; Link, Carol L.; Grant, Richard W.; Marceau, Lisa D.; McKinlay, John B.

doi:10.1016/j.healthpol.2008.06.007

Cited by 42Clinical Reasoning and Diagnostic SkillsDiversity and Career in MedicineSex and Gender in Healthcare

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

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Lutfey, Karen E., Link, Carol L., Grant, Richard W., Marceau, Lisa D., McKinlay, John B.·2009·Health Policy

DOI 10.1016/j.healthpol.2008.06.007PMC PMC2676675

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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 of subsequent clinical actions, and these varied according to physician and patient 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.

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Eight articles appeared to refer to the same data collected in a single cross-country comparison study, and a further two articles analysed the same data.
“eight articles appeared to refer to the same data collected in a single cross-country comparison study [27–32, 34, 35] and a further two articles analysed the same data [45, 47].”
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Diagnostic Certainty as a Source of Medical Practice Variation in Coronary Heart Disease: Results from a Cross-National Experiment of Clinical Decision Making
Lutfey, K. E., Link, C. L., Marceau, L. D., Grant, R. W., Adams, A., Arber, S., Siegrist, J., Bönte, M., von dem Knesebeck, O., & McKinlay, J. B. (2009) · Medical Decision Making · doi:10.1177/0272989x09331811 · Cited by 37 · see citing works
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Authors: Lutfey, K. E., Link, C. L., Grant, R. W., Marceau, L. D., & McKinlay, J. B.
Affiliations: New England Research Institutes (US)
Harvard University (US)
Corresponding author: Lutfey, Karen E.
ORCID: Grant, Richard W.
Marceau, Lisa D.
Venue: Health Policy
Publisher: Elsevier BV
Published: 2009-03
Volume: 89
Issue: 3
Pages: 279-287
ISSN: 0168-8510 (ISSN-L)
DOI: 10.1016/j.healthpol.2008.06.007
PMC: PMC2676675
OpenAlex: W2029990752
Cited by: 42
References: 56
Citations by year: 2026: 1 · 2025: 2 · 2023: 4 · 2022: 2 · 2021: 1 · 2020: 1 · 2018: 3 · 2017: 3 · 2016: 5 · 2015: 2 · 2014: 4 · 2012: 6
FWCI: 1.90
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Health Policy (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
RePEc: Research Papers in Economics (submittedVersion)
Funders: National Institutes of Health
National Institute on Aging (R01 AG16747, R01AG016747)
Topics: Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
Social Sciences › Gender Studies › Diversity and Career in Medicine
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Sex and Gender in Healthcare
Keywords: diagnostic certainty, racial disparities, gender disparities, coronary artery disease, depression, Black patients, young women, patient characteristics, provider characteristics, test ordering, drug prescribing, case vignettes
MeSH terms: Aged, Coronary Disease, Decision Making, Depression, Diagnosis, Differential, Female, Humans, Male, Middle Aged, Physicians, Sex Factors, Videotape Recording, Racial Groups, Health Status Disparities

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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

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