Abstract Background An analysis of Accident Compensation Corporation claims shows “inconsistent and inadequate diagnoses” by health care providers. Diagnostic performance is a result of two independent parameters, namely discrimination (accuracy) and decision (bias). Bias is related to the medical practitioner’s perception of the costs and benefits of making one choice over another. Bias may be statistical, sociological, political, biological or psychological in nature. This study investigated the factors that potentially bias diagnostic decision-making by general practitioners and the subjective value placed on these factors by different stakeholder groups in society. Methods Phase 1 of the study used focus groups of standard setters for general practitioners to identify factors that influenced diagnostic decision-making in general practice. These factors were evaluated for importance and desirability using standard Delphi methodology and Rasch analysis. Phase 2 of the study evaluated the importance and desirability of the factors identified in Phase 1 for influencing decision making as judged by significant health care stakeholder groups in New Zealand. Participant response was via questionnaire analysed by the Rasch Model. Results Thirty-nine factors were identified that potentially biased diagnostic decision-making in general practice. The measurements of, particularly, desirability have high reproducibility across stakeholder groups and high positive loading for the first principal component consistent with construct validity. No stakeholder group identifies factors consistent with Bayes’ theorem of diagnostic reasoning as being the only desirable influence on diagnosis. There is considerable categorical homogeneity between the stakeholder groups GP, GPACC, P, RACCSLT and RACCSST. Conclusions The findings of this and other studies challenge the current biomedical paradigm, indicating a less than Bayesian approach to medical decision-making. A social constructivist model, incorporating non-Bayesian factors into the definition of “illness” versus “disease”, may be more representative of reality. A social constructivist model of medicine is incompatible with the current legislatory and administrative framework within which the Accident Compensation Corporation and a number of other medical organisations operate. / Accident Compensation Corporation of New Zealand

Abstract Background An analysis of Accident Compensation Corporation claims shows “inconsistent and inadequate diagnoses” by health care providers. Diagnostic performance is a result of two independent parameters, namely discrimination (accuracy) and decision (bias). Bias is related to the medical practitioner’s perception of the costs and benefits of making one choice over another. Bias may be statistical, sociological, political, biological or psychological in nature. This study investigated the factors that potentially bias diagnostic decision-making by general practitioners and the subjective value placed on these factors by different stakeholder groups in society. Methods Phase 1 of the study used focus groups of standard setters for general practitioners to identify factors that influenced diagnostic decision-making in general practice. These factors were evaluated for importance and desirability using standard Delphi methodology and Rasch analysis. Phase 2 of the study evaluated the importance and desirability of the factors identified in Phase 1 for influencing decision making as judged by significant health care stakeholder groups in New Zealand. Participant response was via questionnaire analysed by the Rasch Model. Results Thirty-nine factors were identified that potentially biased diagnostic decision-making in general practice. The measurements of, particularly, desirability have high reproducibility across stakeholder groups and high positive loading for the first principal component consistent with construct validity. No stakeholder group identifies factors consistent with Bayes’ theorem of diagnostic reasoning as being the only desirable influence on diagnosis. There is considerable categorical homogeneity between the stakeholder groups GP, GPACC, P, RACCSLT and RACCSST. Conclusions The findings of this and other studies challenge the current biomedical paradigm, indicating a less than Bayesian approach to medical decision-making. A social constructivist model, incorporating non-Bayesian factors into the definition of “illness” versus “disease”, may be more representative of reality. A social constructivist model of medicine is incompatible with the current legislatory and administrative framework within which the Accident Compensation Corporation and a number of other medical organisations operate. / Accident Compensation Corporation of New Zealand

Abstract Background An analysis of Accident Compensation Corporation claims shows “inconsistent and inadequate diagnoses” by health care providers. Diagnostic performance is a result of two independent parameters, namely discrimination (accuracy) and decision (bias). Bias is related to the medical practitioner’s perception of the costs and benefits of making one choice over another. Bias may be statistical, sociological, political, biological or psychological in nature. This study investigated the factors that potentially bias diagnostic decision-making by general practitioners and the subjective value placed on these factors by different stakeholder groups in society. Methods Phase 1 of the study used focus groups of standard setters for general practitioners to identify factors that influenced diagnostic decision-making in general practice. These factors were evaluated for importance and desirability using standard Delphi methodology and Rasch analysis. Phase 2 of the study evaluated the importance and desirability of the factors identified in Phase 1 for influencing decision making as judged by significant health care stakeholder groups in New Zealand. Participant response was via questionnaire analysed by the Rasch Model. Results Thirty-nine factors were identified that potentially biased diagnostic decision-making in general practice. The measurements of, particularly, desirability have high reproducibility across stakeholder groups and high positive loading for the first principal component consistent with construct validity. No stakeholder group identifies factors consistent with Bayes’ theorem of diagnostic reasoning as being the only desirable influence on diagnosis. There is considerable categorical homogeneity between the stakeholder groups GP, GPACC, P, RACCSLT and RACCSST. Conclusions The findings of this and other studies challenge the current biomedical paradigm, indicating a less than Bayesian approach to medical decision-making. A social constructivist model, incorporating non-Bayesian factors into the definition of “illness” versus “disease”, may be more representative of reality. A social constructivist model of medicine is incompatible with the current legislatory and administrative framework within which the Accident Compensation Corporation and a number of other medical organisations operate. / Accident Compensation Corporation of New Zealand

Abstract Background An analysis of Accident Compensation Corporation claims shows “inconsistent and inadequate diagnoses” by health care providers. Diagnostic performance is a result of two independent parameters, namely discrimination (accuracy) and decision (bias). Bias is related to the medical practitioner’s perception of the costs and benefits of making one choice over another. Bias may be statistical, sociological, political, biological or psychological in nature. This study investigated the factors that potentially bias diagnostic decision-making by general practitioners and the subjective value placed on these factors by different stakeholder groups in society. Methods Phase 1 of the study used focus groups of standard setters for general practitioners to identify factors that influenced diagnostic decision-making in general practice. These factors were evaluated for importance and desirability using standard Delphi methodology and Rasch analysis. Phase 2 of the study evaluated the importance and desirability of the factors identified in Phase 1 for influencing decision making as judged by significant health care stakeholder groups in New Zealand. Participant response was via questionnaire analysed by the Rasch Model. Results Thirty-nine factors were identified that potentially biased diagnostic decision-making in general practice. The measurements of, particularly, desirability have high reproducibility across stakeholder groups and high positive loading for the first principal component consistent with construct validity. No stakeholder group identifies factors consistent with Bayes’ theorem of diagnostic reasoning as being the only desirable influence on diagnosis. There is considerable categorical homogeneity between the stakeholder groups GP, GPACC, P, RACCSLT and RACCSST. Conclusions The findings of this and other studies challenge the current biomedical paradigm, indicating a less than Bayesian approach to medical decision-making. A social constructivist model, incorporating non-Bayesian factors into the definition of “illness” versus “disease”, may be more representative of reality. A social constructivist model of medicine is incompatible with the current legislatory and administrative framework within which the Accident Compensation Corporation and a number of other medical organisations operate. / Accident Compensation Corporation of New Zealand

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Ringtones are a common distracting sound in modern workspaces. In an earlierexperiment, ringtones increasing in volume (looming) produced greater attentional capture effectin the context of serial short-term memory, than ringtones with sudden onsets that decreased involume (receding). To determine whether this effect occurred merely because the loudest part ofthe looming ringtone coincided with the most sensitive part of the serial short-term memory task,this study repeated the sound conditions of the first experiment, but altered their timing. In thisstudy, the onset of the ringtones were brought forward in time such that the loudest part of thelooming ringtone now coincided with the part of the serial short-term memory task wherein theonset of the looming ringtone occurred in the first experiment. The looming ringtone againproduced more disruption than the receding ringtone, which failed to disrupt performance relativeto the quiet control condition. The presence of a masking sound eliminated the looming ringtoneeffect, as in the previous study. The results here support previous work demonstrating that thelooming sounds give rise to attentional capture and that this reflects an evolutionary adaptation tounconsciously react to approaching sounds/objects.

The Aviation Safety Action Program (ASAP) is a voluntary, non-jeopardy reporting program supported by commercial airlines. The program provides pilots with a way to report unsafe occurrences, including their own errors, without risk of punitive action on the part of the airlines or the Federal Aviation Administration (FAA). Through a set of on-site visits to airlines with ASAP programs, deficiencies were identified in the way airlines collect ASAP reports from pilots. It was concluded that these deficiencies might be limiting the ability of airlines to identify hazards contributing to reported safety events. The purpose of this research was to determine if the use of an ASAP reporting form based on a human factors model, referred to as the Threat and Error Management (TEM) model, would result in pilots providing a larger quantity and higher quality of information as compared to information provided by pilots using a standard ASAP reporting form. The TEM model provides a framework for a taxonomy that includes factors related to safety events pilots encounter, behaviors and errors they make, and threats associated with the complexities of their operational environment. A comparison of reports collected using the TEM Reporting Form and a standard reporting form demonstrated that narrative descriptions provided by pilots using the TEM Reporting Form included both a larger quantity and higher quality of information. Quantity of information was measured by comparing the average word count of the narrative descriptions. Quality of information was measured by comparing the discriminatory power of the words in the narrative descriptions and the extent to which the narrative descriptions from the two sets of reports contributed to a set of latent concepts. The findings suggest that the TEM Reporting Form can help pilots provide longer descriptions, more relevant information related to safety hazards, and expand on concepts that contribute to reported safety events. The use of the TEM Reporting Form for the collection of ASAP reports should be considered by airlines as a preferred collection method for improving the quantity and quality of information reported by pilots through ASAP programs. / text

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