The use of clinical information in diagnosing chronic heart failure: A comparison between general practitioners, cardiologists, and students

In a clinical judgement analysis study, 27 general practitioners, 22 cardio logists, and 21 medical students assessed 40 case vignettes with regard to the probability of heart failure, in order to study the weights of differen t kinds of information (cues) measured by the regression coefficients in a multiple regression model. The vignettes were based on actual patients. We found that diagnostic accomplishment and diagnostic strategies were surpris ingly similar on the group level, but very different on the individual leve l. The most important cues for the participants were cardiac enlargement an d pulmonary stasis. Strategies in which cardiac enlargement was the predomi nating cue icd to a higher diagnostic accomplishment; a third of the partic ipants used such strategies. The cues given in the vignettes could have bee n utilized more efficiently; cardiac enlargement seems to be more important and "classical" symptoms less important for predicting heart failure than the participants realize. (C) 2000 Elsevier Science Inc. All rights reserve d.