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The influence of patient's age on clinical decision-making about coronary heart disease in the USA and the UK \ud

By Ann Adams, Christopher D. Buckingham, Sara Arber, John McKinlay, Lisa Marceau and Carol Link

Abstract

This paper examines UK and US primary care doctors' decision-making about older (aged 75 years) and midlife (aged 55 years) patients presenting with coronary heart disease (CHD). Using an analytic approach based on conceptualising clinical decision-making as a classification process, it explores the ways in which doctors' cognitive processes contribute to ageism in health-care at three key decision points during consultations. In each country, 56 randomly selected doctors were shown videotaped vignettes of actors portraying patients with CHD. The patients' ages (55 or 75 years), gender, ethnicity and social class were varied systematically. During the interviews, doctors gave free-recall accounts of their decision-making. The results do not establish that there was substantial ageism in the doctors' decisions, but rather suggest that diagnostic processes pay insufficient attention to the significance of older patients' age and its association with the likelihood of co-morbidity and atypical disease presentations. The doctors also demonstrated more limited use of ‘knowledge structures’ when diagnosing older than midlife patients. With respect to interventions, differences in the national health-care systems rather than patients' age accounted for the differences in doctors' decisions. US doctors were significantly more concerned about the potential for adverse outcomes if important diagnoses were untreated, while UK general practitioners cited greater difficulty in accessing diagnostic tests

Topics: RC
Publisher: Cambridge University Press
Year: 2006
OAI identifier: oai:wrap.warwick.ac.uk:698

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Citations

  1. (1999). A model of probabilistic category learning. doi
  2. (2005). Address for correspondence: Centre for Primary Health Care Studies,
  3. (1996). Adherence to national guidelines for drug treatment of suspected acute myocardial infarction. doi
  4. (1997). Adverse outcomes of underuse of beta-blockers in elderly survivors of acute myocardial infarction. doi
  5. (1986). Age bias: physical therapists and older patients. doi
  6. (2002). Age Discrimination. Policy Position Paper, Age Concern England, London. [Available online at http://www.ace.org.uk] Audit Commission
  7. (2000). Classifying clinical decision-making: a unifying approach. doi
  8. (2000). Classifying clinical decision-making: interpreting nursing intuition, heuristics and medical diagnosis. doi
  9. (1998). clinical decisions about heart disease 319Department of Health
  10. (2001). Clinical manifestations of acute myocardial infarction in older patients. doi
  11. (2001). Diagnosis and management of myocardial ischaemia (angina) in the elderly patient. doi
  12. (2000). Do patients wish to be involved in decision-making in the consultation? A cross-sectional survey with video vignettes. doi
  13. (2003). Does ageism affect the management of ischaemic heart disease? doi
  14. (2001). Eradication of ageism requires tackling the enemy within. doi
  15. (1957). Experimental Designs. Second edition, doi
  16. (1987). Freshmen and senior medical students’ attitudes towards the elderly. doi
  17. Health 2000b. National Service Framework for Coronary Heart Disease: Modern Standards and Service Models. Department of Health,
  18. (1990). Health promotion and disease prevention in the elderly.
  19. (2002). Heart failure in older people: causes, diagnosis and treatment. doi
  20. (1995). Illness presentation in elderly patients. doi
  21. (1983). Is rationality systematic?
  22. (1987). Issues in elderly patient-provider interactions. doi
  23. (1990). Knowledge, attitudes and work preferences regarding the elderly among medical students and practising physicians. doi
  24. (2002). Liberating the Talents: Helping Primary Care Trusts and Nurses to Deliver the NHS Plan.
  25. (2003). Medical decision scripts: combining cognitive scripts and judgment strategies to account fully for medical decision-making. doi
  26. (1997). Morbidity and disability in 75- and 80-year-old men and women: a five year follow-up.
  27. (1996). National patterns of warfarin use in atrial fibrillation. doi
  28. (2001). National Service Framework for Older People. doi
  29. (2000). New Survey of GPs Confirms Ageism in the NHS. Press Release, Age Concern doi
  30. (1996). Non-medical influences on medical decision-making. doi
  31. (2002). Old Habits Die Hard: Tackling Age Discrimination in Health and Social Care. King’s Fund, doi
  32. (2002). Partnerships, performance and primary care: developing integrated services for older people in England. doi
  33. (1997). Patient, physician and presentational influences on clinical decision-making for breast cancer: results from a factorial experiment. doi
  34. (1996). Prognostic value of non-invasive risk stratification in younger and older patients referred for evaluation of suspected coronary artery disease. doi
  35. (1993). Prototype models of concept representation. In
  36. (1998). Skills for Communicating with Patients. doi
  37. (1986). Students’ stereotypes of patients as barriers to clinical decision-making. doi
  38. (2000). The aged cardiovascular risk patient. doi
  39. (1996). The base-rate fallacy reconsidered: descriptive, normative and methodological challenges. doi
  40. (2002). The end of the golden age of doctoring. doi
  41. (1991). The Health of the Nation. Her Majesty’s Stationery Office doi
  42. (1992). The influence of age on policies for admission and thrombolysis in coronary care in the UK. doi
  43. (1987). The Inner Consultation.
  44. (2000). The Medical Interview: The Three-function Approach. doi
  45. (2002). The unexpected influence of physician attributes on clinical decisions: results of an experiment. doi
  46. (1995). Variations in the utilisation of coronary angiography for elderly patients with an acute myocardial infarction: an analysis using hierarchical logistic regression. doi
  47. (1999). Who is targeted for lifestyle advice? A cross-sectional study in two general practices.

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