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Is certainty more important than diagnosis for understanding race and gender disparities?: An experiment using coronary heart disease and depression case vignettes

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  • Lutfey, Karen E.
  • Link, Carol L.
  • Grant, Richard W.
  • Marceau, Lisa D.
  • McKinlay, John B.

Abstract

Objectives To (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.Methods Factorial experiment of 128 generalist physicians using identical clinically authentic videotaped vignettes depicting patients with coronary heart disease (CHD) or depression.Results For 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

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  • Lutfey, Karen E. & Link, Carol L. & Grant, Richard W. & Marceau, Lisa D. & McKinlay, John B., 2009. "Is certainty more important than diagnosis for understanding race and gender disparities?: An experiment using coronary heart disease and depression case vignettes," Health Policy, Elsevier, vol. 89(3), pages 279-287, March.
    • Handle: RePEc:eee:hepoli:v:89:y:2009:i:3:p:279-287
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    1. Van Ryn, M. & Fu, S.S., 2003. "Paved with good intentions: Do public health and human service providers contribute to racial/ethnic disparities in health?," American Journal of Public Health, American Public Health Association, vol. 93(2), pages 248-255.
    2. Balsa, Ana I. & McGuire, Thomas G., 2003. "Prejudice, clinical uncertainty and stereotyping as sources of health disparities," Journal of Health Economics, Elsevier, vol. 22(1), pages 89-116, January.
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    4. van Ryn, Michelle & Burke, Jane, 2000. "The effect of patient race and socio-economic status on physicians' perceptions of patients," Social Science & Medicine, Elsevier, vol. 50(6), pages 813-828, March.
    5. Balsa, Ana I. & McGuire, Thomas G., 2001. "Statistical discrimination in health care," Journal of Health Economics, Elsevier, vol. 20(6), pages 881-907, November.
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    2. Drewniak, Daniel & Krones, Tanja & Sauer, Carsten & Wild, Verina, 2016. "The influence of patients’ immigration background and residence permit status on treatment decisions in health care. Results of a factorial survey among general practitioners in Switzerland," Social Science & Medicine, Elsevier, vol. 161(C), pages 64-73.
    3. Fiebig, D.G. & Viney, R. & Haas, M. & Knox, S. & Street, D. & Weisberg, E. & Bateson, D., 2015. "Complexity and doctor choices when discussing contraceptives," Health, Econometrics and Data Group (HEDG) Working Papers 15/14, HEDG, c/o Department of Economics, University of York.
    4. Jakobsson, Niklas & Kotsadam, Andreas & Syse, Astri & Øien, Henning, 2016. "Gender bias in public long-term care? A survey experiment among care managers," Journal of Economic Behavior & Organization, Elsevier, vol. 131(PB), pages 126-138.
    5. Tritter, Jonathan Q. & Lutfey, Karen & McKinlay, John, 2014. "What are tests for? The implications of stuttering steps along the US patient pathway," Social Science & Medicine, Elsevier, vol. 107(C), pages 37-43.
    6. Lay-Yee, Roy & Scott, Alastair & Davis, Peter, 2013. "Patterns of family doctor decision making in practice context. What are the implications for medical practice variation and social disparities?," Social Science & Medicine, Elsevier, vol. 76(C), pages 47-56.

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