Evidence map›Paper›PMID 28465538›Full record

ArticleScientific reports2017

How doctors diagnose diseases and prescribe treatments: an fMRI study of diagnostic salience.

Marcio Melo, Gustavo D F Gusso, Marcelo Levites, Edson Amaro, Eduardo Massad, Paulo A Lotufo, Peter Zeidman, Cathy J Price, Karl J Friston

Open access · goldAbstract read
In one paragraph

Article in Scientific reports, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
0.5field-weighted citation impact, top 35% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 8 citations in OpenAlex.

  1. CLINICAL REASONING AND ARTIFICIAL INTELLIGENCE: CAN AI REALLY THINK?Transactions of the American Clinical and Climatological Association · 2024
    Article
  2. Clinical Reasoning in Cardiology: Past, Present and Future.Arquivos brasileiros de cardiologia · 2022
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 2 institutions in 2 countries.

Marcio MeloLaboratory of Medical Investigations, LIM-01, Faculty of Medicine of the University of São Paulo, Av. Dr. Arnaldo 455, São Paulo, 01246-904, Brazil. marciomelo@me.com.
Gustavo D F GussoDepartment of Internal Medicine, Faculty of Medicine of the University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 155, São Paulo, 05403-000, Brazil.
Marcelo LevitesDepartment of Internal Medicine, Faculty of Medicine of the University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 155, São Paulo, 05403-000, Brazil.
Edson AmaroAlbert Einstein Israelite Hospital, IIEP, Av. Albert Einstein 627, São Paulo, 05652-900, Brazil.
Eduardo MassadLaboratory of Medical Investigations, LIM-01, Faculty of Medicine of the University of São Paulo, Av. Dr. Arnaldo 455, São Paulo, 01246-904, Brazil.
Paulo A LotufoDepartment of Internal Medicine, Faculty of Medicine of the University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 155, São Paulo, 05403-000, Brazil.
Peter ZeidmanWellcome Trust Centre for Neuroimaging, University College London, 12 Queen Square, London, WC1N 3BG, United Kingdom.
Cathy J PriceWellcome Trust Centre for Neuroimaging, University College London, 12 Queen Square, London, WC1N 3BG, United Kingdom.
Karl J FristonWellcome Trust Centre for Neuroimaging, University College London, 12 Queen Square, London, WC1N 3BG, United Kingdom.ORCID http://orcid.org/0000-0001-7984-8909
Universidade de São Paulo · BRWellcome Centre for Human Neuroimaging · GB

Funding

Medical Research Council MR/M023672/1Wellcome Trust 205103/Z/16/Z
6 · The paper itself

Abstract

Understanding the brain mechanisms involved in diagnostic reasoning may contribute to the development of methods that reduce errors in medical practice. In this study we identified similar brain systems for diagnosing diseases, prescribing treatments, and naming animals and objects using written information as stimuli. Employing time resolved modeling of blood oxygen level dependent (BOLD) responses enabled time resolved (400 milliseconds epochs) analyses. With this approach it was possible to study neural processes during successive stages of decision making. Our results showed that highly diagnostic information, reducing uncertainty about the diagnosis, decreased monitoring activity in the frontoparietal attentional network and may contribute to premature diagnostic closure, an important cause of diagnostic errors. We observed an unexpected and remarkable switch of BOLD activity within a right lateralized set of brain regions related to awareness and auditory monitoring at the point of responding. We propose that this neurophysiological response is the neural substrate of awareness of one's own (verbal) response. Our results highlight the intimate relation between attentional mechanisms, uncertainty, and decision making and may assist the advance of approaches to prevent premature diagnostic closure.

Indexed as

PhysiciansAdultAttentionBrainBrain MappingDecision MakingDiagnostic Techniques and ProceduresFemaleHumansMagnetic Resonance ImagingMaleMedical ErrorsMiddle Aged

Identifiers

PMID28465538
PMCPMC5430984
OpenAlexW2607753638

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

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.