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

Bibliographic Data

ID11200935
AuthorsAnn Adams (0000-0003-0807-9465, University of Warwick), Christopher D Buckingham (0000-0002-3675-1215, Aston University), Sara Arber (University of Surrey), John B Mckinlay (New England Research Institutes), Lisa Marceau (0000-0001-5002-1588, New England Research Institutes), Carol L Link (New England Research Institutes), Carol Link
Year2006
Volume26
Issue2
Pages303-321
Publication date2006-03-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueAgeing and Society (JOURNAL)
Journal identifiersISSN: 0144-686X • E-ISSN: 1469-1779
PublisherCambridge University Press (CUP) (PUBLISHER)
DOI10.1017/s0144686x05004265
OpenAlexW1966865415
LanguageEN
Citations received7
References cited9

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

Cognition · Coronary heart disease · Disease · Ethnic group · Family medicine · Health care · Medical diagnosis · Pathology · Psychiatry · Psychological intervention · Recall · Aging and Gerontology Research · Clinical Reasoning and Diagnostic Skills · Empathy and Medical Education · Medicine · Psychology · Gerontology