Programme no. 122-OP
Professional Development
Cognitive strategies for primary care diagnosis: Hypothesis testing and triggered routines
Stefan Bösner*1, Anna Maria Sikeler2, Norbert Donner-Banzhoff3, Judith Seidel4, 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 phases called hypothesis testing and triggered routines on the basis of empiric data.
Background: In cognitive psychology dichotomous tasks and related cognitive strategies have been elaborately researched. Established knowledge about how individuals approach ill-defined or polychotomous tasks and how valid and useful their strategies are, is still rare.

In the setting of general practice there is a wide range of different diagnoses and the GP has to differentiate reliably between frequently encountered and rare diseases.

Results: 282 patient consultations contained 163 diagnostic episodes; in 63 von 163 (39%) of these GPs applied the strategy of deductive hypothesis testing. Triggered routines were used in 62 of 163 (38%) diagnostic episodes. Use of triggered routines showed a large variety between different GPs and seemed to correlate with the frequency of consultations addressing respiratory, urogenital or gastrointestinal problems.
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: Both hypotheses testing and triggered routines are part of the GP’s ‘adaptive toolbox’ when dealing with ill-defined diagnostic problems.
Points for discussion:
  1. What triggered routines do you use in your daily practice?
  2. Do you prefer triggered routines for certain types of consultations?