ArticleMedical decision making : an international journal of the Society for Medical Decision Making2017
The Role of Physicians' First Impressions in the Diagnosis of Possible Cancers without Alarm Symptoms.
Article in Medical decision making : an international journal of the Society for Medical Decision Making, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 1 of them a synthesis that pooled it.
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Who cites it
28 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Pooled it
- Differential diagnosis checklists reduce diagnostic error differentially: A randomised experiment.Medical education · 2021Trial
- Effects of a Differential Diagnosis List of Artificial Intelligence on Differential Diagnoses by Physicians: An Exploratory Analysis of Data from a Randomized Controlled Study.International journal of environmental research and public health · 2021Trial
- Is C-reactive protein the answer to antibiotics over-prescribing in primary care? A behavioural experiment in two European countries.JAC-antimicrobial resistance · 2026Article
- Educational Frameworks for Diagnostic Decision-Making in AI-Enhanced Head and Neck Pathology.Head and neck pathology · 2026Review
- Independent and collaborative performance of large language models and healthcare professionals in diagnosis and triage.NPJ digital medicine · 2026Article
- Comparison of Physician Assistant and Medical Students' Clinical Reasoning Processes Using an Online Patient Simulation Tool to Support Clinical Reasoning (eCREST): Mixed Methods Study.JMIR medical education · 2025Article
- Potential for reducing confirmation bias using the OMP model "6-microskills" with verbalizing discordance: a cross-sectional study.BMC medical education · 2025Article
- Clinical decision-making on lung cancer investigations in primary care: a vignette study.BMJ open · 2024Article
- Intergroup time bias and aversive racism in the medical context.Journal of personality and social psychology · 2024Article
- Observational
- Influences of early diagnostic suggestions on clinical reasoning.Cognitive research: principles and implications · 2022Article
- Algorithm-based advice taking and clinical judgement: impact of advice distance and algorithm information.Cognitive research: principles and implications · 2022Article
- Incidence of Diagnostic Errors Among Unexpectedly Hospitalized Patients Using an Automated Medical History-Taking System With a Differential Diagnosis Generator: Retrospective Observational Study.JMIR medical informatics · 2022Article
- [Diagnostic error and overdiagnosis in Primary Care. Proposals for the improvement of clinical practice family medicine].Atencion primaria · 2021Review
- Do different response formats affect how test takers approach a clinical reasoning task? An experimental study on antecedents of diagnostic accuracy using a constructed response and a selected response format.Advances in health sciences education : theory and practice · 2021Article
- Can decision support combat incompleteness and bias in routine primary care data?Journal of the American Medical Informatics Association : JAMIA · 2021Article
- GPs' perspectives of the patient encounter - in the context of standardized cancer patient pathways.Scandinavian journal of primary health care · 2020Article
- Association between use of urgent suspected cancer referral and mortality and stage at diagnosis: a 5-year national cohort study.The British journal of general practice : the journal of the Royal College of General Practitioners · 2020Article
- [Effect of the use of heuristics on diagnostic error in Primary Care: Scoping review].Atencion primaria · 2020Article
Corrections and comments
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Authors and funding
5 authors.
Funding
Abstract
backgroundFirst impressions are thought to exert a disproportionate influence on subsequent judgments; however, their role in medical diagnosis has not been systematically studied. We aimed to elicit and measure the association between first impressions and subsequent diagnoses in common presentations with subtle indications of cancer.
methodsNinety UK family physicians conducted interactive simulated consultations online, while on the phone with a researcher. They saw 6 patient cases, 3 of which could be cancers. Each cancer case included 2 consultations, whereby each patient consulted again with nonimproving and some new symptoms. After reading an introduction (patient description and presenting problem), physicians could request more information, which the researcher displayed online. In 2 of the possible cancers, physicians thought aloud. Two raters coded independently the physicians' first utterances (after reading the introduction but before requesting more information) as either acknowledging the possibility of cancer or not. We measured the association of these first impressions with the final diagnoses and management decisions.
resultsThe raters coded 297 verbalizations with high interrater agreement (Kappa = 0.89). When the possibility of cancer was initially verbalized, the odds of subsequently diagnosing it were on average 5 times higher (odds ratio 4.90 [95% CI 2.72 to 8.84], P < 0.001), while the odds of appropriate referral doubled (OR 1.98 [1.10 to 3.57], P = 0.002). The number of cancer-related questions physicians asked mediated the relationship between first impressions and subsequent diagnosis, explaining 29% of the total effect.
conclusionWe measured a strong association between family physicians' first diagnostic impressions and subsequent diagnoses and decisions. We suggest that interventions to influence and support the diagnostic process should target its early stage of hypothesis generation.
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