Lampe Lisa, Fritz Kristina, Boyce Philip, Starcevic Vladan, Brakoulias Vlasios, Walter Garry, Shadbolt Narelle, Harris Anthony, Malhi Gin
Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
Australas Psychiatry. 2013 Jun;21(3):231-7. doi: 10.1177/1039856213486210. Epub 2013 Apr 25.
The objective of this article is to explore diagnostic decision making around psychological symptoms presenting to general practitioners (GPs) and psychiatrists, identify attitudinal and personality factors of possible relevance in these decisions, and compare GPs and psychiatrists to help identify potential educational targets.
GPs and psychiatrists attended separate peer-facilitated workshops in which two case presentations were discussed. Decision making was explored by structured questions embedded in the workshop, with responses recorded by electronic keypad technology. Participants completed demographic questionnaires and measures of personality and attitudes to depression.
GPs and psychiatrists accorded emphasis to different elements of the history, and assigned different diagnoses based on the same set of symptoms. Both groups relied on non-pharmacological management for milder psychological symptoms; GPs were less likely to make a diagnosis of bipolar disorder. Traits of Extraversion and Agreeableness were associated with greater ease in treating depression.
Differences in diagnostic decision making likely reflect the different contexts of specialist and generalist practice. Educational targets may include information about key symptoms to assist in diagnostic precision, but further information is needed to determine the best match between diagnostic processes, context and outcome. An awareness of the role of personality factors may help when designing education and support programs.
本文旨在探讨全科医生（GP）和精神科医生对呈现心理症状患者的诊断决策过程，识别这些决策中可能相关的态度和人格因素，并比较全科医生和精神科医生，以确定潜在的教育目标。
全科医生和精神科医生分别参加由同行主持的研讨会，会上讨论了两个病例报告。通过研讨会中设置的结构化问题来探究决策过程，其回答由电子键盘技术记录。参与者完成了人口统计学问卷以及人格和对抑郁症态度的测量。
全科医生和精神科医生对病史的不同要素予以不同程度的重视，且基于同一组症状给出了不同的诊断。两组都对较轻的心理症状采用非药物治疗；全科医生诊断为双相情感障碍的可能性较小。外向性和宜人性特质与更轻松地治疗抑郁症相关。
诊断决策的差异可能反映了专科医生和全科医生不同的执业背景。教育目标可能包括有关关键症状的信息，以提高诊断准确性，但还需要更多信息来确定诊断过程、背景和结果之间的最佳匹配。在设计教育和支持项目时，了解人格因素的作用可能会有所帮助。
