Experience and Diagnostic Anchors in Referral Letters

Abstract

Abstract. The present study investigated whether diagnostic anchors, that is: diagnoses suggested in referral letters, influence judgments made by clinical psychologists with different levels of experience. Moderately experienced clinicians (N = 98) and very experienced clinicians (n = 126) were randomly assigned to reading a referral letter suggesting either depression or anxiety, or no referral letter. They then read a psychiatric report about a depressed patient, and gave a preliminary and final diagnosis. Results showed that the correctness of the diagnoses by very experienced clinicians was unaffected by the referral diagnosis. Moderately experienced clinicians did use the suggested diagnosis as anchor; when they had read a referral letter suggesting depressive complaints they were more inclined to classify the patient with a depressive disorder. In conclusion, the diagnosis in a referral letter influences the diagnostic decision made by moderately experienced clinicians.

Diagnostic Accuracy in Australian Psychologists: Impact of Experience and Endorsement on the Anchoring Effect

“…Using an Australian sample of psychologists, this study examined the effects of experience levels, endorsement status, and anchoring from GP referral letters on diagnostic accuracy. It was hypothesised that the findings would mirror those found by Spaanjaars et al () in their European sample, in that anchoring would occur and that experience would reduce the effects of anchoring. Furthermore, endorsement was expected to be predictive of improved diagnostic accuracy.…”

“…Anchoring biases have been identified in many studies examining diagnostic and prognostic errors in clinical judgements (Croskerry, ; Friedlander & Stockman, ; Mumma & Wilson, ; Richards & Wierzbicki, ; Spaanjaars, Groenier, van de Ven, & Witteman, ). However, anchoring effects have not consistently been generated in all similar experiments (Ellis, Robbins, Schult, Ladany, & Banker, ; Friedlander & Phillips, ; Pfeiffer, Whelan, & Martin, ).…”

“…However, anchoring effects have not consistently been generated in all similar experiments (Ellis, Robbins, Schult, Ladany, & Banker, ; Friedlander & Phillips, ; Pfeiffer, Whelan, & Martin, ). While methodological differences between the studies may account for some of these divergent findings, others suggest that a clinician's level of experience may contribute to the impact of anchoring bias in diagnostic decisions and thus explain some of the differences observed (Friedlander & Phillips, ; Spaanjaars et al, ).…”

“…Spaanjaars et al () examined this notion directly by comparing a group of “very experienced” (+10 years) and “intermediately experienced” (2–10 years) psychologists in an experiment measuring diagnostic anchors in referral letters from general practitioners (GPs). In their study, Spaanjaars et al () asked clinicians to provide a preliminary and final diagnosis based on information provided about a real de‐identified client. They varied the conditions such that the participants were randomly allocated to one of three groups.…”

“…In summary, this study aimed to build upon previous research by conducting a replication and expansion in an Australian context based on the work of Spaanjaars et al (). Using an Australian sample of psychologists, this study examined the effects of experience levels, endorsement status, and anchoring from GP referral letters on diagnostic accuracy.…”