Affective influences on clinical reasoning and diagnosis: insights from social psychology and new research opportunities

Diagnosis ◽  
2022 ◽  
Vol 0 (0) ◽  
Author(s):  
Guanyu Liu ◽  
Hannah Chimowitz ◽  
Linda M. Isbell
Keyword(s):  
Social Psychology ◽  
Decision Making ◽  
Patient Safety ◽  
Clinical Reasoning ◽  
Improve Patient Safety ◽  
Healthcare Providers ◽  
Diagnostic Errors ◽  
Psychological Research ◽  
Medical Decision ◽  
Great Promise

Abstract Psychological research consistently demonstrates that affect can play an important role in decision-making across a broad range of contexts. Despite this, the role of affect in clinical reasoning and medical decision-making has received relatively little attention. Integrating the affect, social cognition, and patient safety literatures can provide new insights that promise to advance our understanding of clinical reasoning and lay the foundation for novel interventions to reduce diagnostic errors and improve patient safety. In this paper, we briefly review the ways in which psychologists differentiate various types of affect. We then consider existing research examining the influence of both positive and negative affect on clinical reasoning and diagnosis. Finally, we introduce an empirically supported theoretical framework from social psychology that explains the cognitive processes by which these effects emerge and demonstrates that cognitive interventions can alter these processes. Such interventions, if adapted to a medical context, hold great promise for reducing errors that emerge from faulty thinking when healthcare providers experience different affective responses.

Psychology and the New Private Law

2020 ◽  
pp. 124-142
Author(s):  
Tess Wilkinson-Ryan
Keyword(s):  
Social Psychology ◽  
Decision Making ◽  
Law And Economics ◽  
Mental States ◽  
Psychological Research ◽  
Private Law ◽  
Legal Decision ◽  
Psychological Analysis ◽  
Legal Decision Making ◽  
Normative Models

This chapter presents a framework for understanding the most promising contributions of psychological methods and insights for private law. It focuses on two related domains of psychological research: cognitive and social psychology. Cognitive psychology is the study of mental processes, which one might shorthand as “thinking.” Social psychology asks about the role of other people—actual, implied, or imagined—on mental states and human behavior. The chapter is oriented around five core psychological insights: calculation, motivation, emotion, social influence, and moral values. Legal scholarship by turns tries to explain legal decision-making, tries to calibrate incentives, and tries to justify its values and its means. Psychology speaks to these descriptive, prescriptive, and normative models of decision-making. The chapter then argues that psychological analysis of legal decision-making challenges the work that the idea of choice and preference is doing in private law, especially in the wake of the law and economics movement.

Lessons in clinical reasoning – pitfalls, myths, and pearls: the contribution of faulty data gathering and synthesis to diagnostic error

Diagnosis ◽  
2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Martin A. Schaller-Paule ◽  
Helmuth Steinmetz ◽  
Friederike S. Vollmer ◽  
Melissa Plesac ◽  
Felix Wicke ◽  
...  
Keyword(s):  
Patient Safety ◽  
Clinical Reasoning ◽  
Data Gathering ◽  
Diagnostic Errors ◽  
Diagnostic Error ◽  
Care Physician ◽  
Diagnostic Process ◽  
Myasthenic Crisis ◽  
Hospital Organization ◽  
Substantial Impact

Abstract Objectives Errors in clinical reasoning are a major factor for delayed or flawed diagnoses and put patient safety at risk. The diagnostic process is highly dependent on dynamic team factors, local hospital organization structure and culture, and cognitive factors. In everyday decision-making, physicians engage that challenge partly by relying on heuristics – subconscious mental short-cuts that are based on intuition and experience. Without structural corrective mechanisms, clinical judgement under time pressure creates space for harms resulting from systems and cognitive errors. Based on a case-example, we outline different pitfalls and provide strategies aimed at reducing diagnostic errors in health care. Case presentation A 67-year-old male patient was referred to the neurology department by his primary-care physician with the diagnosis of exacerbation of known myasthenia gravis. He reported shortness of breath and generalized weakness, but no other symptoms. Diagnosis of respiratory distress due to a myasthenic crisis was made and immunosuppressive therapy and pyridostigmine were given and plasmapheresis was performed without clinical improvement. Two weeks into the hospital stay, the patient’s dyspnea worsened. A CT scan revealed extensive segmental and subsegmental pulmonary emboli. Conclusions Faulty data gathering and flawed data synthesis are major drivers of diagnostic errors. While there is limited evidence for individual debiasing strategies, improving team factors and structural conditions can have substantial impact on the extent of diagnostic errors. Healthcare organizations should provide the structural supports to address errors and promote a constructive culture of patient safety.

scholarly journals Value-impregnated factual claims may undermine medical decision-making

2018 ◽  
Vol 13 (3) ◽  
pp. 151-158 ◽  
Author(s):  
Niels Lynøe ◽  
Gert Helgesson ◽  
Niklas Juth
Keyword(s):  
Decision Making ◽  
Medical Decision Making ◽  
Clinical Decision Making ◽  
Negative Impact ◽  
Personal Values ◽  
Healthcare Providers ◽  
Clinical Decision ◽  
Medical Decision ◽  
Clinical Decisions ◽  
Soft Laws

Clinical decisions are expected to be based on factual evidence and official values derived from healthcare law and soft laws such as regulations and guidelines. But sometimes personal values instead influence clinical decisions. One way in which personal values may influence medical decision-making is by their affecting factual claims or assumptions made by healthcare providers. Such influence, which we call ‘value-impregnation,’ may be concealed to all concerned stakeholders. We suggest as a hypothesis that healthcare providers’ decision making is sometimes affected by value-impregnated factual claims or assumptions. If such claims influence e.g. doctor–patient encounters, this will likely have a negative impact on the provision of correct information to patients and on patients’ influence on decision making regarding their own care. In this paper, we explore the idea that value-impregnated factual claims influence healthcare decisions through a series of medical examples. We suggest that more research is needed to further examine whether healthcare staff’s personal values influence clinical decision-making.

scholarly journals Shared leadership in tertiary care: design of a simulation for patient safety decision-making in healthcare management teams

2020 ◽  
pp. bmjstel-2020-000627
Author(s):  
Lisa Aufegger ◽  
Emma Soane ◽  
Ara Darzi ◽  
Colin Bicknell
Keyword(s):  
Decision Making ◽  
Patient Safety ◽  
Real World ◽  
Shared Leadership ◽  
Improve Patient Safety ◽  
Tertiary Care ◽  
Management Training ◽  
Healthcare Management ◽  
Self Report ◽  
Good Opportunity

IntroductionSimulation-based training (SBT) on shared leadership (SL) and group decision-making (GDM) can contribute to the safe and efficient functioning of a healthcare system, yet it is rarely incorporated into healthcare management training. The aim of this study was design, develop and validate a robust and evidence-based SBT to explore and train SL and GDM.MethodUsing a two-stage iterative simulation design approach, 103 clinical and non-clinical managerial students and healthcare professionals took part in an SBT that contained real-world problems and opportunities to improve patient safety set within a fictional context. Self-report data were gathered, and a focus group was conducted to address the simulation’s degree of realism, content, relevance, as well as areas for improvement.ResultsParticipants experienced the simulation scenario, the material and the role assignment as realistic and representative of real-world tasks and decision contexts, and as a good opportunity to identify and enact relevant tasks, behaviours and knowledge related to SL and GDM. Areas for improvement were highlighted with regard to involving an actor who challenges SL and GDM; more preparatory time to allow for an enhanced familiarisation of the content; and, video debriefs to reflect on relevant behaviours and team processes.ConclusionsOur simulation was perceived as an effective method to develop SL and GDM within the context of patient safety and healthcare management. Future studies could extend this scenario method to other areas of healthcare service and delivery, and to different sectors that require diverse groups to make complex decisions.

Sex as Reported in a Recent Sample of Psychological Research

1977 ◽  
Vol 2 (2) ◽  
pp. 157-161 ◽  
Author(s):  
Patrice Reardon ◽  
Suzanne Prescott
Keyword(s):  
Social Psychology ◽  
Decision Making ◽  
Psychological Research ◽  
Sharp Drop ◽  
Single Sex ◽  
Recent Sample ◽  
Scientific Decision ◽  
Reporting Procedures ◽  
Scientific Reporting

This study is a follow up on the study done by Sara Schwabacher (1972). All the articles in this study were taken from the Journal of Personality and Social Psychology 1974, volume 30, and were reviewed for sex of subjects, type of conclusions drawn, and whether sex was mentioned in the abstract, introduction, or methods section. These results were compared to the Schwabacher study in order to discover if the conditions noted in her study continue to prevail, or whether there has been a change in scientific sampling and reporting procedures. Contrary to the previous study, the percentage of all male studies show a sharp drop of 15% while all female studies rose 22%. When comparing the amount of single sex studies overgeneralized, all-male studies remained proportionately the same, whereas overgeneralized all-female studies showed an increase of 35.5%. In addition more both-sex articles checked for sex differences than previously reported. The authors discuss the results in relation to the women's movement and scientific decision making. Three suggestions for scientific reporting and procedures are made.

scholarly journals INTERACTIVE LEARNING IN THE COURSE OF INTERNAL MEDICINE: STEPS IN MAKING DIAGNOSIS

2020 ◽  
Vol 20 (2) ◽  
pp. 248-252
Author(s):  
T.G. Shekhovtseva ◽  
M.О. Dolinna
Keyword(s):  
Decision Making ◽  
Professional Training ◽  
Medical Decision Making ◽  
Interactive Learning ◽  
Diagnostic Errors ◽  
Educational Process ◽  
Medical Decision ◽  
Diagnostic Process ◽  
Clinical Thinking ◽  
Medical University

Current trends in the development of the Ukrainian education system provide a new approach to the organization of educational process. A doctor must know the algorithm of the diagnostic process and medical decision-making peculiarities underlying the making diagnosis. This requires constant improvement as the number of law cases has demonstrated that diagnostic errors are merely not due to physician’s insufficient medical qualification but often as a consequence of violation of the basic procedural laws. Studying the theory of medial diagnosis stimulates the development of clinical thinking. The purpose of this work was to systematize the main stages in making diagnosis and to outline the ways of their implementation through the interactive learning. The study involved the medical students of Zaporizhzhia State Medical University. The methodology included theoretical systematic analysis of scientific and methodological literature as well as own experience in applying interactive learning. The main motivating factor in the professional training organization should be focused on the professionally oriented use of material and fostering students’ own experience. Under these conditions, the importance of a semiotic approach to the diagnosis of diseases is increasing, i.e. the process of disease identification relies on the ability to catch and to recognise its signs. When making a diagnosis, the doctor has to rely on facts only. This is described as "clinical thinking." The interactive learning in the courses of various disciplines in the program of medical doctor training is being actively implemented at Zaporszhzhia State Medical University. It provides the opportunity for more pronounced pedagogical influence, which induces students to be more active in mastering the program, as well as to demonstrate creativity and research for solving various tasks in daily class practice. Deep understanding the theory of medical decision-making process and making diagnosis greatly contributes to clinical thinking.

scholarly journals Assessment of Patient Safety Culture among Healthcare Providers

2020 ◽  
Vol 13 (2) ◽  
pp. 59
Author(s):  
Hilal H. Alrahbi ◽  
Shamsa K. Al-Toqi ◽  
Sajini Sony ◽  
Nuha Al-Abri
Keyword(s):  
Patient Safety ◽  
Safety Culture ◽  
Improve Patient Safety ◽  
Healthcare Providers ◽  
Patient Safety Culture ◽  
Study Data ◽  
Average Percentage ◽  
Royal Court ◽  
Correlational Design ◽  
Quality Of Patient Care

PURPOSE: Patient safety is an important element in ensuring quality of patient care and accreditation. This study aimed to assess the perception of patient safety culture among the healthcare providers; assess the areas of strength and improvement related to patient safety culture; and assess the relationship between patient safety culture and demographic variables of the sample. METHOD: Descriptive correlational design was employed in this study. Data was collected using the Hospital Survey on Patient Safety Culture (HSPSC). A stratified random sample of 158 healthcare providers from the Diwan of Royal Court Health Complex in Muscat participated in this study. RESULTS: The findings of this study indicated that most of the participants responded positively to the HSPSC items. The average percentage of positive responses was 56.4%. The major areas of strength were “teamwork within department,” “feedback and communication about errors,” and “organizational learning-continuous improvement” (83%, 77%, & 75%; respectively). The major areas of improvement were “frequency of events reported,” “teamwork across departments,” “non-punitive response to errors” and “overall perception of PS” (34%, 42%, 45% & 47%; respectively). Significant differences found were across “patient contact” characteristic [t (156) = 2.142, p = .034]; across “work specializations” [F (3, 154) = 2.84, p = .04]; and across “years of experience at the institution” [F (4, 153) = 4.86, p = .004]. CONCLUSION: A culture that is safe for healthcare providers to work is paramount to minimize adverse events and save patients’ lives. The findings of this study provide a foundation for further interventions to improve patient safety culture. 

Evidence of increasing public participation in advance care planning: a comparison of polls in Alberta between 2007 and 2013

2016 ◽  
Vol 9 (2) ◽  
pp. 189-196 ◽  
Author(s):  
J E Simon ◽  
S Ghosh ◽  
D Heyland ◽  
T Cooke ◽  
S Davison ◽  
...  
Keyword(s):  
Decision Making ◽  
Advance Care Planning ◽  
Healthcare Providers ◽  
Healthcare Systems ◽  
Medical Decision ◽  
Care Planning ◽  
Future Health ◽  
Advance Care ◽  
Definition Of ◽  
Over Time

BackgroundAdvance care planning (ACP) encompasses both verbal and written communications expressing preferences for future health and personal care and helps prepare people for healthcare decision-making in times of medical crisis. Healthcare systems are increasingly promoting ACP as a way to inform medical decision-making, but it is not clear how public engagement in ACP activities is changing over time.MethodsRaw data from 3 independently conducted public polls on ACP engagement, in the same Canadian province, were analysed to assess whether participation in ACP activities changed over 6 years.ResultsStatistically significant increases were observed between 2007 and 2013 in: recognising the definition of ACP (54.8% to 80.3%, OR 3.37 (95% CI 2.68 to 4.24)), discussions about healthcare preferences with family (48.4% to 59.8%, OR 1.41 (95% CI 1.17 to 1.69)) and with healthcare providers (9.1% to 17.4%, OR 1.98 (95% CI 1.51 to 2.59)), written ACP plans (21% to 34.6%, OR 1.77 (95% CI 1.45 to 2.17)) and legal documentation (23.4% to 42.7%, OR 2.13 (95% CI 1.75 to 2.59)). These remained significant after adjusting for age, education and self-rated health status.ConclusionsACP engagement increased over time, although the overall frequency remains low in certain elements such as discussing ACP with healthcare providers. We discuss factors that may be responsible for the increase and provide suggestions for healthcare systems or other public bodies seeking to stimulate engagement in ACP.

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