Anna Maria Sikeler

Bio: Anna Maria Sikeler is an academic researcher from University of Marburg. The author has an hindex of 1, co-authored 1 publications receiving 22 citations.

The phenomenology of the diagnostic process: A primary-care based survey

Abstract: Background. While dichotomous tasks and related cognitive strategies have been extensively researched in cognitive psychology, little is known about how primary care practitioners (general practitioners [GPs]) approach ill-defined or polychotomous tasks and how valid or useful their strategies are. Objective. To investigate cognitive strategies used by GPs for making a diagnosis. Methods. In a cross-sectional study, we videotaped 282 consultations, irrespective of presenting complaint or final diagnosis. Reflective interviews were performed with GPs after each consultation. Recordings of consultations and GP interviews were transcribed verbatim and analyzed using a coding system that was based on published literature and systematically checked for reliability. Results. In total, 134 consultations included 163 diagnostic episodes. Inductive foraging (i.e., the initial, patient-guided search) could be identified in 91% of consultations. It contributed an average 31% of cues obtained by the GP in 1 consultat...

Specifics of medical data mining for diagnosis aid: A survey

Abstract: Data mining continues to play an important role in medicine; specifically, for the development of diagnosis aid models used in expert and intelligent systems. Although we can find abundant research on this topic, clinicians remain reluctant to use decision support tools. Social pressure explains partly this lukewarm position, but concerns about reliability and credibility are also put forward. To address this reticence, we emphasize the importance of the collaboration between both data miners and clinicians. This survey lays the foundation for such an interaction, by focusing on the specifics of diagnosis aid, and the related data modeling goals. On this regard, we propose an overview on the requirements expected by the clinicians, who are both the experts and the final users. Indeed, we believe that the interaction with clinicians should take place from the very first steps of the process and throughout the development of the predictive models, thus not only at the final validation stage. Actually, against a current research approach quite blindly driven by data, we advocate the need for a new expert-aware approach. This survey paper provides guidelines to contribute to the design of daily helpful diagnosis aid systems.

Diagnostic Fluidity: Working with uncertainty and mutability

Abstract: Diagnostic procedures are emblematic of medical work. Scholars in the field of social studies of medicine identify diverse dimensions of diagnosis that point to controversies, processual qualities and contested evidence. In this anthology, diagnostic fluidity is seen to permeate diagnostic work in a wide range of contexts, from medical interactions in the clinic, domestic settings and other relations of affective work, to organizational structures, and in historical developments. The contributors demonstrate, each in their own way, how different agents ‘do diagnosis’, highlighting the multi-faceted elements of uncertainty and mutability integral to diagnostic work. At the same time, the contributors also show how in ‘doing diagnosis’ enactments of subjectivities, representations of cultural imaginaries, bodily processes, and socio-cultural changes contribute to configuring diagnostic fluidity in significant ways.

Solving the Diagnostic Challenge: A Patient-Centered Approach

Abstract: Arriving at an agreed-on and valid explanation for a clinical problem is important to patients as well as to clinicians. Current theories of how clinicians arrive at diagnoses, such as the threshold approach and the hypothetico-deductive model, do not accurately describe the diagnostic process in general practice. The problem space in general practice is so large and the prior probability of each disease being present is so small that it is not realistic to limit the diagnostic process to testing specific diagnoses on the clinician's list of possibilities. Here, new evidence is discussed about how patients and clinicians collaborate in specific ways, in particular, via a process that can be termed inductive foraging, which may lead to information that triggers a diagnostic routine. Navigating the diagnostic challenge and using patient-centered consulting are not separate tasks but rather synergistic.

Relationships Between Medical Doctors’ Personality Traits and Their Professional Risk Perception

Abstract: Medical decision-making is often related to risk and uncertainty, but existing research does not offer a comprehensive approach to this matter. We discuss the necessity to study cognitive representations of risks (CRRs), which we define as the subject’s images of risky situations, possible outcomes, and alternative decisions. The psychometric approach towards risk assessment often involves the evaluation of different risks, but we aim to create such a list from medical professionals’ expert knowledge. Via qualitative analysis, CRRs were obtained from interviews with practicing doctors from Russia (N = 24). The list includes 21 risks from real-life medical practice, with seven aspects for numerical evaluation each. Then, practicing doctors (N = 64) evaluated CRRs along with filling risk-related personality traits questionnaires: Personal Decision-Making Factors Questionnaire, Melbourne Decision Making Questionnaire, Ten Item Personality Measure, and Budner’s Intolerance of Ambiguity Scale. A correlational analysis showed interconnections between most CRRs aspects, with predictability and negative outcome probability seemingly being the central aspects of the risk assessment. CRRs aspects were also found to be gender- and experience-specific, with female doctors and younger specialists being more sensitive to professional risks. Personality traits in relation to CRRs aspects, medical experience and gender are also discussed.

Beyond accuracy: hidden motives in diagnostic testing.

Abstract: Background Diagnostic decision-making is usually disease-focussed and intended to examine the patient's medical condition accurately. But diagnostic interventions may serve further purposes that are not yet fully understood. Objective To explore GPs' diagnostic behaviour not related to confirming or refuting a specific disease. Methods We recorded 295 primary care consultations in 12 practices. One hundred thirty-four consultations comprised at least one diagnostic episode. GPs were asked to reflect on their own diagnostic thinking in interviews for every single case. Qualitative and quantitative analyses were applied with focus on the GPs' cognitive processes during diagnostic decision-making. Results Primary care physicians clearly stated that they requested some tests for other reasons than diagnosing disease. A feeling of uncertainty stimulated diagnostic procedures aiming to regulate the anticipation of regret. We identified patients' reassurance, patients' requests and strategic issues as further motives for diagnostic actions. Conclusion Besides focussing on disease in the diagnostic process, emotional and strategic goals are hidden motives that play a critical role in clinical decision-making. They might even represent an initial factor in a cascade of interventions leading to overdiagnosis. How GPs might control these influences provides an important aspect for further research, practice and teaching.