Physician Cognitive Processing as a Source of Diagnostic and Treatment Disparities in Coronary Heart Disease: Results of a Factorial Priming Experiment
Open accessAbstract
Literature on health disparities documents variations in clinical decision-making across patient characteristics, physician attributes, and among health care systems. Using data from a vignette-based factorial experiment of 256 primary care providers, we examine the cognitive basis of disparities in the diagnosis and treatment of coronary heart disease (CHD). We explore whether previously observed disparities are due to physicians (1) not fully considering CHD for certain patients or (2) considering CHD but then discounting it. Half of the physicians in the experiment were primed with explicit directions to consider a CHD diagnosis, and half were not. Relative to their unprimed counterparts, primed physicians were more likely to order CHD-related tests and prescriptions. However, the main effects for patient gender and age remained, suggesting that physicians treated these demographic variables as diagnostic features indicating lower risk of CHD for these patients. This finding suggests that physician appeals to perceived base rates have the potential to contribute to the further reification of socially constructed health statistics.
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Many assumption studies attempted to make their vignettes as realistic as possible by having them validated by clinicians and by having participants view/read the vignettes as part of a normal day at work.
“many of the assumption studies attempted to make their vignettes as realistic as possible by having them validated by clinicians [25–41] and also by having participants view/read the vignettes as part of a normal day at work [27–36, 39, 41].”
From Implicit bias in healthcare professionals: a systematic review (2017) · cites this paper as [33]
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- Authors
- Lutfey, K. E., Eva, K. W., Gerstenberger, E., Link, C. L., & McKinlay, J. B.
- Affiliations
- New England Research Institutes (US)
- McMaster University (CA)
- Corresponding author
- Lutfey, Karen E.
- ORCID
- Eva, Kevin W.
- Venue
- Journal of Health and Social Behavior
- Publisher
- SAGE Publications
- Published
- 2010-03
- Volume
- 51
- Issue
- 1
- Pages
- 16-29
- ISSN
- 0022-1465 (ISSN-L)
- 2150-6000
- PMC
- PMC3120017
- OpenAlex
- W2114789700
- Cited by
- 32
- References
- 49
- Citations by year
- 2026: 1 · 2023: 1 · 2022: 3 · 2021: 2 · 2019: 1 · 2018: 1 · 2017: 3 · 2016: 4 · 2015: 3 · 2014: 3 · 2013: 3 · 2012: 5
- FWCI
- 2.92
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Health and Social Behavior (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (R01HL079174)
- Topics
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Social Sciences › Health › Health disparities and outcomes
- Keywords
- coronary artery disease, health disparities, diagnostic disparities, treatment disparities, primary care providers, base rates, gender bias, age bias, diagnostic bias, vignette experiment
- MeSH terms
- Cognition, Coronary Disease, Decision Making, Female, Humans, Interviews as Topic, Male, Physicians, Videotape Recording, Healthcare Disparities
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