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An Experimental Study of the Clinical Judgment of General Physicians in Evaluating and Prescribing for Depression

Published online by Cambridge University Press:  29 January 2018

Hans-Ueli Fisch ,
Kenneth R. Hammond ,
C. R. B. Joyce  and
Michael O'Reilly
Hans-Ueli Fisch
Affiliation:
Psychiatrische Poliklinik, University of Bern, Murtenstrasse 21, CH–3010 Bern, Switzerland
Kenneth R. Hammond
Affiliation:
Center for Research on Judgment and Policy, University of Colorado, Boulder, Colorado, 80309, USA
C. R. B. Joyce
Affiliation:
Medical Department, CIBA–Geigy Limited, CH–4002 Basel, Switzerland
Michael O'Reilly
Affiliation:
Center for Research on Judgment and Policy, University of Colorado, Boulder, Colorado, 80309, USA
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Summary

Fifteen general physicians were given profiles of symptom combinations representing 80 depressed patients. They were asked to judge the severity of the disorder and to prescribe. There were two phases to the experiment the formal structure of both being the same. In the first phase, all physicians based their judgments only on the cues of the Hamilton Depression scale; in the second, each physician defined his own cues. Multivariate regression analysis was applied to the observations. Agreement between the judges was low. Most had a more complex policy, in regard to both judgment of the severity of the depression and prescribing, when selecting their own cues than when restricted to textbook variables, but used it more consistently. The observations have important implications for training and research in psychiatry and in psychopharmacology.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 138 , Issue 2 , February 1981 , pp. 100 - 109
Copyright
Copyright © Royal College of Psychiatrists, 1981 

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References

Basagni, M. Baroni, L. & Lucchelli, P. E. (1977) Diagnostic policies of minor depressive illness by two differently trained groups of general practitioners. International Journal of Clinical Pharmacology, 15, 474–479.Google Scholar
Bielski, R. J. & Friedel, R. O. (1976) Prediction of tricyclic antidepressant response. Archives of General Psychiatry, 33, 1479–1489.CrossRefGoogle ScholarPubMed
Chen, Ch-N .(1979) Sleep, depression and antidepressants. British Journal of Psychiatry, 135, 385–402.Google Scholar
Dawes, R. M. (1971) A case study of graduate admissions: Application of three principles of human decision making. American Psychologist, 26, 180–188.Google Scholar
Dawes, R. M. & Corrigan, B. (1974) Linear models in decision making. Psychological Bulletin, 81, 95–106.CrossRefGoogle Scholar
De Dombal, F. T. (1978) Medical diagnosis from a clinician's point of view. Methods of Information in Medicine, 17, 28–35.Google Scholar
Elstein, A. S. Shulman, L. S. & Sprafka, S. A. (1978) Medical Problem Solving. Cambridge, Massachusetts: Harvard University Press.Google Scholar
Feinstein, A. R. (1967) Clinical Judgment. Huntington, New York: Robert E. Krieger.Google Scholar
Gift, T. E. Strauss, J. S. Ritzler, B. A. Kokes, R. F. & Harder, D. W. (1980) How diagnostic concepts of schizophrenia differ. Journal of Nervous and Mental Disease, 168, 3–8.Google Scholar
Grinker, R. R. Miller, J. B. Sabshin, M Nunn, R. & Nunnally, J. C. (1961) The Phenomena of Depressions. New York: Harper and Row.Google Scholar
Hamilton, M. (1967) Development of a rating scale for primary depressive illness. British Journal of Social and Clinical Psychology, 6, 278–296.Google Scholar
Hammond, K. R. (1971) Computer graphics as an aid to learning. Science, 172, 903–908.CrossRefGoogle ScholarPubMed
Hammond, K. R. Stewart, T. R. Brehmer, B. & Steinmann, D. O. (1975) Social judgment theory. In: Human Judgment and Decision Processes (eds. M. F. Kaplan and S. Schwartz). New York: Academic Press.Google Scholar
Hammond, K. R. & Adelman, L. (1976) Science, values, and human judgment. Science, 194, 389–396.Google Scholar
Hammond, K. R. & Joyce, C. R. B. (1977) Psychological influences on human judgement, especially of adverse reactions. In: Drug Monitoring (eds. F. H. Gross and W. H. W. Inman). London: Academic Press.Google Scholar
Harrow, M. & Amdur, M. J. A. (1971) Guilt and depressive disorders. Archives of General Psychiatry, 25, 240–246.CrossRefGoogle Scholar
Hemminski, E. (1975) Review of literature on the factors affecting drug prescribing. Social Science and Medicine, 9, 111–115.CrossRefGoogle Scholar
Henry, B. W. Overall, J. E. & Woodward, J. A. (1976) Actuarial justification for choice of drug treatment for psychiatric treatment. Diseases of the Nervous System, 37, 555–557.Google Scholar
Joyce, C. R. B. Last, J. M. & Weatherall, M. (1967) Personal factors as a cause of difference in prescribing by general practitioners. British Journal of Preventive and Social Medicine, 21, 170–177.Google Scholar
Joyce, C. R. B. Berry, H. Chaput, De Saintonge, M Domenet, J. Fowler, P. & Mason, R. M. (1977) Judgment analysis of investigators' assessments: a way to reduce one important source of error in multi-centre trials. Eular Bulletin, Monograph 1. Google Scholar
Kendell, R. E. (1973) Psychiatric diagnoses: a study of how they are made. British Journal of Psychiatry, 122, 437–445.CrossRefGoogle Scholar
Kendell, R. E. (1975) The Role of Diagnosis in Psychiatry. Oxford: Blackwell Scientific Publications.Google Scholar
Montgomery, S. A. & Asberg, M. (1979) A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382–389.Google Scholar
Relman, A. S. (1979) Recertification: will we retreat? The New England Journal of Medicine, 301, 778–779.CrossRefGoogle ScholarPubMed
Shapiro, M. B. (1979) The relation of guilt and other feelings to the diagnosis of depression. British Journal of Medical Psychology, 52, 123–132.Google Scholar
Slovic, P. Rorer, L. G. & Hoffman, P. J. (1971) Analyzing the use of diagnostic signs. Investigative Radiology, 6, 18–26.CrossRefGoogle ScholarPubMed
Stewart, T. R. Joyce, C. R. B. & Lindell, M. (1975) New analyses: application of judgment theory to physicians' judgment of drug effects. In: Psychoactive Drugs and Social Judgment (eds. K. R. Hammond and C. R. B. Joyce). New York: Wiley.Google Scholar
Zung, W. W. K. (1977) Operational diagnosis and diagnostic categories of depressive disorders. In: Phenomenology and Treatment of Depression (eds. W. E. Fann, I. Karacan, A. D. Pokorny and R. L. Williams). New York: Spectrum Publications.Google Scholar
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