How Missing Information in Diagnosis Can Lead to Disparities in the Clinical Encounter
How Missing Information in Diagnosis Can Lead to Disparities in the Clinical Encounter
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DOI：
10.1097/01.phh.0000338384.82436.0d
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发表时间：
2008-11-01
影响因子：
3.3
通讯作者：
Normand, Sharon-Lise
中科院分区：
文献类型：
--
作者：
Alegria, Margarita;Nakash, Ora;Normand, Sharon-Lise
先前的研究已经记录了诊断偏差，并指出减少诊断偏差可以消除误诊并改善心理健康服务的提供。很少有研究调查临床医生在初次临床接触期间获取和使用信息的方法。我们描述了一项研究，该研究检查了少数族裔患者的诊断评估过程中临床医生偏差的影响。总共对 129 名心理健康患者进行了录像，涉及来自 8 个主要安全网诊所的 47 名心理健康临床医生。视频由另一位临床医生使用信息清单进行编码，对原始临床医生提供的诊断视而不见。我们发现临床医生在物质相关疾病方面的一致性较高，在抑郁症和焦虑症（恐慌除外）方面的一致性较低。大多数临床医生依靠患者提及的抑郁、焦虑或药物滥用来识别疾病，而不评估具体标准。在诊断信息有限的情况下，临床医生可以优化临床摄入时间以与患者建立融洽的关系。我们发现拉丁裔种族是症状报告与抑郁症诊断可能性之间关联的一个修正因素。根据患者种族对症状区域进行差异化讨论可能会导致鉴别诊断并增加诊断偏倚的可能性。
Previous studies have documented diagnostic bias and noted that its reduction could eliminate misdiagnosis and improve mental health service delivery. Few studies have investigated clinicians' methods of obtaining and using information during the initial clinical encounter. We describe a study examining contributions to clinician bias during diagnostic assessment of ethnic/racial minority patients. A total of 129 mental health intakes were videotaped, involving 47 mental health clinicians from 8 primarily safety-net clinics. Videos were coded by another clinician using an information checklist, blind to the diagnoses provided by the original clinician. We found high levels of concordance between clinicians for substance-related disorders, low levels for depressive disorders, and anxiety disorders except panic. Most clinicians rely on patients' mention of depression, anxiety, or substance use to identify disorders, without assessing specific criteria. With limited diagnostic information, clinicians can optimize the clinical intake time to establish rapport with patients. We found Latino ethnicity to be a modifying factor of the association between symptom reports and likelihood of a depression diagnosis. Differential discussion of symptom areas, depending on patient ethnicity, may lead to differential diagnosis and increased likelihood of diagnostic bias.