DIAGNOSTIC CUES IN GASTROENTEROLOGY

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Abstract
Gastroenterologists (15 physicians and 12 surgeons) were evaluated to understand their policy in the usage and weighting of clues in making a diagnosis. This was a relatively small sample, and, on account of possible sampling bias, only tentative generalizations were made. Five case vignettes, each consisting of 4-8 clues, were used. Subjects were asked to give their percentage likelihood estimates of various diagnostic possibilities after each clue. This gave an indication of their perception of the significance of various clues in relationship to each diagnosis. There were marked variations in clue weighting by these experts, and, in particular, most individuals were far off the mean regarding the weighting of certain clinical features, thus displaying idiosyncratic behavior in these instances. As may be expected, there were differences in disease prevalence estimates between physicians and surgeons. Early information had an overwhelming effect on the final diagnosis. In most cases the expert relied on a few critical cues rather than on a pattern to make a diagnosis. In view of the strong influences of early diagnostic formulations, these findings confirm the need for doctors to learn to use and collect accurate factual information on prevalence rates and on the most significant critical clues for various disease processes. The study highlights some of the problems faced by novices in learning from experts who may teach them contradictory information about what are the most significant factors in coming to a diagnosis.

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