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

Ann Adams, Christopher D. Buckingham, Sara Arber, John B. McKinlay, Lisa Marceau, Carol Link

Research output: Contribution to journalArticle

Abstract

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.
Original languageEnglish
Pages (from-to)303-321
Number of pages19
JournalAgeing and Society
Volume26
Issue number2
Early online date27 Feb 2006
DOIs
Publication statusPublished - 1 Mar 2006

Fingerprint

heart disease
Coronary Disease
decision making
diagnostic
Ageism
health care
comorbidity
general practitioner
social class
Decision Making
ethnicity
Disease
Delivery of Health Care
gender
interview
Routine Diagnostic Tests
Social Class
General Practitioners
knowledge
Clinical Decision-Making

Keywords

  • ageism
  • primary health care
  • coronary heart disease
  • classification
  • decision-making
  • cognitive processess
  • health inequalities

Cite this

Adams, Ann ; Buckingham, Christopher D. ; Arber, Sara ; McKinlay, John B. ; Marceau, Lisa ; Link, Carol. / The influence of patient's age on clinical decision-making about coronary heart disease in the USA and the UK. In: Ageing and Society. 2006 ; Vol. 26, No. 2. pp. 303-321.
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The influence of patient's age on clinical decision-making about coronary heart disease in the USA and the UK. / Adams, Ann; Buckingham, Christopher D.; Arber, Sara; McKinlay, John B.; Marceau, Lisa; Link, Carol.

In: Ageing and Society, Vol. 26, No. 2, 01.03.2006, p. 303-321.

Research output: Contribution to journalArticle

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