TL;DR: It is suggested that ‘inductive foraging’ is a relevant and appropriate mode of data acquisition for the first part of the patient encounter, and inductive foraging is a rational and efficient diagnostic strategy.
Abstract: Background: Physicians attempting to make a diagnosis arrive at specific hypotheses early in their encounter with patients. Further data are collected in the light of these early hypotheses. While this hypothetico-deductive model has been accepted as both a description of physicians’ data gathering and a norm, little attention has been paid to the preceding stage of the consultation.Hypothesis: It is suggested that ‘inductive foraging’ is a relevant and appropriate mode of data acquisition for the first part of the patient encounter.Methods: Research evidence from cognitive psychology and medical reasoning research is discussed.Results: With inductive foraging, ‘pattern failure’ rather than ‘pattern recognition’ is the mode of discovery. Largely, guidance should be left to the patient to lead the clinician into areas where departures from normality are to be found. This is in contrast to active and focused ‘deductive inquiry,’ which should be used only after most aetiologies, but a few have elimin...
TL;DR: The amount of medical information laypeople recall, investigate the impact of structured presentation on recall and recommend the physician to friends to improve recall are assessed.
Abstract: Objective Assess the amount of medical information laypeople recall, investigate the impact of structured presentation on recall Methods 105 first-year psychology students (mean age 215 ± 38 years; 85% female) were randomised to two information-presentation conditions: structured (S group) and nonstructured (NS group) Students watched a video of a physician discharging a patient from the emergency department In the S Group, content (28 items of information) was divided into explicit “chapters” with “chapter headings” preceding new information Afterwards, participants wrote down all information they recalled on an empty sheet of paper Results The S group ( N = 57) recalled significantly more items than NS group ( N = 41) (812 ± 431 vs 571 ± 373; p = 0005), rated information as easier to understand (80 ± 19 vs 61 ± 22; p p p Conclusion University students recalled around 7/28 items of information presented Explicit structure improved recall Practice implications Practitioners must reduce the amount of information conveyed and structure information to improve recall
Cites result from "Inductive foraging: improving the d..."
...Yet our results showed that information on red flags and medication was not well recalled ....
TL;DR: Physicians in Germany should be more aware of the culturally based expectations of immigrant patients in order to understand their needs better, improve the physician-patient relationship, and ensure equal opportuities in health care.
Abstract: In the context of medical care migrants are often seen as difficult; this is the result of a lack of linguistic understanding, poorer compliance, and different disease concepts (1, 2). Primary care physicians report feeling uncertain, helpless, and even angry when working with migrants (2, 3). However, migration-specific health-care research almost always focuses on the point of view of medical professionals (4); little is known about immigrants’ own experiences. Whether they can report experiences similar to those of native-born citizens is an issue of interest.
The participants in the study presented here were first-generation Russian-speaking immigrants from the former Soviet Union. This group is the second-largest immigrant population in Germany and consists mainly of ethnic Germans, including late emigres (“Russian-Germans”) and their relatives, Jewish immigrants, and migrants with other residency rights. For simplicity, Russian-speaking participants are referred to hereafter as “migrants,” and native-born citizens with no background of migration as “Germans,” even though most of the Russian-speaking participants are of German origin.
No research has yet been conducted into the expectations or experiences of Russian-speaking immigrants in a medical context. There is therefore no existing information on whether migrants are as integrated into medical care, in terms of equality of opportunity, as native-born citizens are.
Qualitative methods should be used both to develop a hypothesis for further substudies and to investigate the following questions:
How do migrants and Germans experience primary care? Do the two groups have the same experiences?
What expectations do immigrants and Germans have of their primary care physicians?
TL;DR: Cognitive strategies used by GPs for making a diagnosis are investigated to suggest that GPs organize their search for information in a skillfully adapted way and the testing of specific disease hypotheses seems to play a lesser role than previously thought.
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...
Cites background from "Inductive foraging: improving the d..."
...It can be terminated by the patient or by the physician interrupting the patient.(5) Inductive foraging is more than the patient stating a presenting complaint....
...Otherwise, GPs will interrupt the patient prematurely, take control of communication, and inordinately restrict the range of possible explanations.(5)...
...‘‘Inductive foraging’’ not only eases the patient’s sense of distress but is essential to define the diagnostic problem space.(5) The worlds of patient-centered medicine and diagnostic reasoning can thereby be reconciled....
TL;DR: The authors present the three-level architecture of the multi-UAV-based forest firefighting monitoring system; features of patrolling, confirming, and monitoring missions; as well as functions of UAV in such missions.
Abstract: This work presents a monitoring system for tactical forest fire-fighting operations based on a team of unmanned aerial vehicles and remote sensing techniques. Functions and missions of the system, as well as its architecture, are considered. Image processing and remote sensing algorithms are presented, a way for data integration into a fire-spreading model in a real-time forest fire response decision support system is proposed. The combination of automatic monitoring and remote sensing techniques with an approximate fire-spreading model can provide required credibility and efficiency of fire prediction and response.
TL;DR: 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.
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.
Abstract: Described by the philosopher A.J. Ayer as a work of 'great originality and power', this book revolutionized contemporary thinking on science and knowledge. Ideas such as the now legendary doctrine of 'falsificationism' electrified the scientific community, influencing even working scientists, as well as post-war philosophy. This astonishing work ranks alongside The Open Society and Its Enemies as one of Popper's most enduring books and contains insights and arguments that demand to be read to this day.
Abstract: A theory of norms and normality is presented and applied to some phenomena of emotional responses, social judgment, and conversations about causes. Norms are assumed to be constructed ad hoc by recruiting specific representations. Category norms are derived by recruiting exemplars. Specific objects or events generate their own norms by retrieval of similar experiences stored in memory or by construction of counterfactual alternatives. The normality of a stimulus is evaluated by comparing it to the norms that it evokes after the fact, rather than to precomputed expectations. Norm theory is applied in analyses of the enhanced emotional response to events that have abnormal causes, of the generation of predictions and inferences from observations of behavior, and of the role of norms in causal questions and answers. This article is concerned with category norms that represent knowledge of concepts and with stimulus norms that govern comparative judgments and designate experiences as surprising. In the tradition of adaptation level theory (Appley, 1971; Helson, 1964), the concept of norm is applied to events that range in complexity from single visual displays to social interactions. We first propose a model of an activation process that produces norms, then explore the role of norms in social cognition. The central idea of the present treatment is that norms are computed after the event rather than in advance. We sketch a supplement to the generally accepted idea that events in the stream of experience are interpreted and evaluated by consulting precomputed schemas and frames of reference. The view developed here is that each stimulus selectively recruits its own alternatives (Garner, 1962, 1970) and is interpreted in a rich context of remembered and constructed representations of what it could have been, might have been, or should have been. Thus, each event brings its own frame of reference into being. We also explore the idea that knowledge of categories (e.g., "encounters with Jim") can be derived on-line by selectively evoking stored representations of discrete episodes and exemplars. The present model assumes that a number of representations can be recruited in parallel, by either a stimulus event or an
Abstract: This paper introduces a theoretical framework that describes the importance of affect in guiding judgments and decisions. As used here, “affect” means the specific quality of “goodness” or “badness” (i) experienced as a feeling state (with or without consciousness) and (ii) demarcating a positive or negative quality of a stimulus. Affective responses occur rapidly and automatically—note how quickly you sense the feelings associated with the stimulus word “treasure” or the word “hate”. We argue that reliance on such feelings can be characterized as “the affect heuristic”. In this paper we trace the development of the affect heuristic across a variety of research paths followed by ourselves and many others. We also discuss some of the important practical implications resulting from ways that this heuristic impacts our daily lives.
Abstract: Strategies for hypothesis testing in scientific investigation and everyday reasoning have interested both psychologists and philosophers. A number of these scholars stress the importance of disconfir. marion in reasoning and suggest that people are instead prone to a general deleterious "confirmation bias" In particula~ it is suggested that people tend to test those cases that have the best chance of verifying current beliefs rather than those that have the best chance of falsifying them. We show, howeve~ that many phenomena labeled "confirmation bias" are better understood in terms of a general positive test strate~. With this strategy, there is a tendency to test cases that are expected (or known) to have the property of interest rather than those expected (or known) to lack that property. This strategy is not equivalent to confirmation bias in the first sense; we show that the positive test strategy can be a very good heuristic for determining the truth or falsity of a hypothesis under realistic conditions~ It can, howeve~ lead to systematic errors or inefficiencies. The appropriateness of human hypotheses-testing strategies and prescriptions about optimal strategies must he understood in terms of the interaction between the strategy and the task at hand.