1. TITLE: Use of Heuristics during the clinical decision process from family physicians in real conditions
  2. SHORT TITLE: Heuristics in primary care physicians
  3. AUTHORS: Carmen Fernández-Aguilar, José Jesús Martín-Martín, Sergio Minué Lorenzo & Alberto Fernández-Ajuria.
  4. AFFILIATIONS
Carmen Fernández Aguilar (CFA), Legal and Business Sciences Department, Professor at the Isabel I University, Calle de Fernán González, 76, 09003 Burgos (Spain),carmen.fernandez.aguilar@ui1.es, Phone number: +34 689979214
José Jesús Martín (JJM), Professor at the University of Granada, Applied Economics Department, Paseo de Cartuja, 7, 18011, Granada (Spain),jmartin@ugr.es
Sergio Minué (SM), Professor at the Andalusian School of Public Health, Cuesta del Observatorio, 4, 18011, Granada (Spain),sminue21@gmail.com
Alberto Fernández Ajuria, Professor at the Andalusian School of Public Health, Cuesta del Observatorio, 4, 18011, Granada (Spain). alberto.fernandez.easp@juntadeandalucia.es
ABSTRACT AND KEYWORDS
Rationale aims and objectives : The available evidence regarding the existence and consequences of the use of heuristics in the clinical decision process is very scarce. The purpose of this study is to measure the use of the Representativeness, Availability and Overconfidence heuristics in real conditions with Primary Care physicians in cases of dyspnoea and to study the possible correlation with diagnostic error.
Methods: A prospective cohort study was carried out in 4 Primary Care centres in which 371 new cases of dyspnoea were registered. The use of the three heuristics in the diagnostic process is measured through an operational definition of the aforementioned. Subsequently, the statistical correlation with the identified clinical errors is analysed.
Results: In 9.97% of the registered cases a diagnostic error was identified. In 49.59% of the cases, the physicians used the representativeness heuristic in the diagnostic decision process. The availability heuristic was used by 82.38% of the doctors and finally, in more than 50% of the cases, the doctors showed excess confidence. None of the heuristics showed a statistically significant correlation with diagnostic error.
Conclusion : The three heuristics have been used as mental shortcuts by Primary Care physicians in the clinical decision process in cases of dyspnoea, but their influence on the diagnostic error is not significant. New studies based on the proposed methodology will enable the confirmation of both its importance and its association with diagnostic error.
KEYWORDS : heuristics; medical decision making; primary care; diagnostic error; cognitive process; general practice.
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