Langwieler and Linden (1993)

aim

to investigate if biases associated with a clinician’s professional background exist in medical decision-making

method

combo of qualitative methods, such as covert observation, interviews & content analysis

procedure

a pseudo-patient was trained and presented to 4 clinicians, who all had varying professional backgrounds (ex: behaviourist vs. psychoanalytic training)

the pseudo-patient was a physician, but was posing as a clerk

• she reported symptoms that fit the DSM-III symptoms for MDD

all the clinicians gave informed consent to participating in a study on medical decision-making

the pseudo-patient recorded the interview session on a recorder

after the study, the clinicians listened to the recording along with the researchers, and stated their thoughts during the interview

• these comments were transcribed & submitted for content analysis

results

all clinicians arrived at slightly different diagnostic conclusions

• medication was prescribed by some clinicians but not by others

• suicidal thoughts were investigated by some but not others

initial diagnosis was formed early on

• a conclusion was made early in the interview

• subsequent questions or assessments were formatted to fit this early-formed conclusion

conclusion

clinician biases likely played a role in diagnosis

this contradicts the idea of a standardized diagnostic process

strengths

pseudo-patient being a clinician - was aware of the diagnostic process & could perhaps prompt questions for further clarification (ex: aren’t you going to ask me any other questions?)

• could purposely provide symptoms that go against the DSM-III’s symptoms of MDD, in order to see if these new symptoms affect the diagnosis

clinicians hving different professional background - also allows for understanding of how professional background influences diagnosis, or influences how the symptoms are interpret

informed consent - no ethical issues

hving the clinician’s listen to the recording - allowed the researchers to understand the clinician’s thought process - what symptoms led to the diagnosis or how did they want to conduct the interview

limitations

cant rlly be applied to today’s environment - clinicians hv more training & DSM-5 is updated

• study could be replicated to observe if clinical biases are still present tday

perhaps it is not bias that played a role in diagnosis, but instead that the clinicians had already seen cases similar to the pseudo-patient

• instinctively knew the patient had MDD

implications + applications

overall highlights the role of clinical biases in diagnoses

more training has to be done to improve validity of diagnosis