ArticleHealth policy (Amsterdam, Netherlands)2009
Is certainty more important than diagnosis for understanding race and gender disparities?: an experiment using coronary heart disease and depression case vignettes.
Article in Health policy (Amsterdam, Netherlands), 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
19 citing papers in PubMed, 1 synthesis or guideline pooled it, 41 citations in OpenAlex.
- Implicit bias in healthcare professionals: a systematic review.BMC medical ethics · 2017Pooled it
- Physician clinical information technology and health care disparities.Medical care research and review : MCRR · 2009Trial
- Influence of race and gender on variability in clinical decision-making in neurology.Scientific reports · 2025Article
- Gender Differences in Clinical Practice Regarding Coronary Heart Disease: A Systematic Review.Journal of clinical medicine · 2025Review
- Who has mental health problems? Comparing individual, social and psychiatric constructions of mental health.Social psychiatry and psychiatric epidemiology · 2024Article
- Racial differences in low value care among older adult Medicare patients in US health systems: retrospective cohort study.BMJ (Clinical research ed.) · 2023Article
- Preventing and Experiencing Ischemic Heart Disease as a Woman: State of the Science: A Scientific Statement From the American Heart Association.Circulation · 2016Review
- Gaps in preparedness of clergy and healthcare providers to address mental health needs of returning service members.Journal of religion and health · 2015Article
- Physicians' anxiety due to uncertainty and use of race in medical decision making.Medical care · 2014Article
- Gendered uncertainty and variation in physicians' decisions for coronary heart disease: the double-edged sword of "atypical symptoms".Journal of health and social behavior · 2012Article
- The effect of imaging on the clinical management of breast pain.Journal of general internal medicine · 2012Article
- Differences between internists and family practitioners in the diagnosis and management of the same patient with coronary heart disease.Medical care research and review : MCRR · 2011Article
- Diagnosis and management of depression in 3 countries: results from a clinical vignette factorial experiment.The primary care companion for CNS disorders · 2011Article
- Physician cognitive processing as a source of diagnostic and treatment disparities in coronary heart disease: results of a factorial priming experiment.Journal of health and social behavior · 2010Article
- The effects of patient characteristics on ADHD diagnosis and treatment: a factorial study of family physicians.BMC family practice · 2010Article
- Do physicians attend to base rates? Prevalence data and statistical discrimination in the diagnosis of coronary heart disease.Health services research · 2009Article
- What happens along the diagnostic pathway to CHD treatment? Qualitative results concerning cognitive processes.Sociology of health & illness · 2009Article
- Disparities in physicians' interpretations of heart disease symptoms by patient gender: results of a video vignette factorial experiment.Journal of women's health (2002) · 2009Article
- Diagnostic certainty as a source of medical practice variation in coronary heart disease: results from a cross-national experiment of clinical decision making.Medical decision making : an international journal of the Society for Medical Decision MakingArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 3 institutions in 1 country.
Funding
Abstract
objectivesTo (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.
methodsFactorial experiment of 128 generalist physicians using identical clinically authentic videotaped vignettes depicting patients with coronary heart disease (CHD) or depression.
resultsFor 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.
conclusionsPhysicians 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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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.