Programme no. 121-OP
Professional Development
Cognitive strategies for primary care diagnosis: Inductive foraging
Stefan Bösner*1, Judith Seidel2, Norbert Donner-Banzhoff3, Anna Maria Sikeler4, Odette Wegwarth5, Markus Feufel6, Gerd Gigerenzer7, Wolfgang Gaissmaier8
1General Practice/Family Medicine,University of Marburg,Marburg,Germany, 2General Practice/Family Medicine,University of Marburg,Marburg,Germany, 3General Practice/Family Medicine,University of Marburg,Marburg,Germany, 4General Practice/Family Medicine,University of Marburg,Marburg,Germany, 5Harding Center for Risk Literacy,Max-Planck-Institute for Human Development,Berlin,Germany, 6Harding Center for Risk Literacy, Max-Planck-Institute for Human Development,Berlin,Germany, 7Harding Center for Risk Literacy,Max-Planck-Institute for Human Development,Berlin,Germany, 8Social Psychology and Decision Sciences,University of Konstanz,Konstanz,Germany
* = Presenting author
Objectives: To illustrate the diagnostic phase called inductive foraging on the basis of empiric data. Our aim was to investigate how GPs use this first part of the diagnostic process for information search and cue generation.
Background: While dichotomous tasks and related cognitive strategies have been largely investigated in cognitive psychology there is still little known about how individuals approach ill-defined or polychotomous tasks and how valid or useful their strategies are. Since a wide range of diagnoses may occur in General Practice, this is an example for ill-defined tasks.
Results: 134 out of 282 patient consultations contained at least one diagnostic episode; 122 (91%) of these contained an episode of inductive foraging (IF). IF lasted from 6-176 seconds (median 34 seconds) and was opened in 83 (71%) of cases with a general open question. Patients offered between 1-10 cues per episode (median 4.5 cues). IF was ended in 43% of cases by the patient and in 57% by the GP.
Material/Methods: Data acquisition occurred from 282 unselected patient consultations recruited from 12 GP practices in the vicinity of Marburg. All patients who gave their informed consent were included, independent from their present complaints or previous known illnesses. Consultations were video-taped; in addition all GPs were interviewed directly after the consultation using a semi-structured questionnaire and had to comment on their diagnostic reasoning. All recordings were transcribed and coded by two independent researchers using a code tree based on researched literature on medical reasoning.
Conclusion: Inductive Foraging is an important diagnostic strategy in general practice and constitutes an effective diagnostic pathway at the beginning of the consultation process, especially in situations of high uncertainty.
Points for discussion:
  1. Listening to the patient – an effective strategy in the busy climate of a GP surgery?
  2. How can cues be effectively recognized in the phase of inductive foraging?