Explaining variability the role of health professionals health beliefs

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collected subsequent to the development of a hypothesis may be systematically
distorted to support the original hypothesis (Wallsten 1978). Furthermore, the type
of hypothesis has been shown to bias the collection and interpretation of any
information received during the consultation (Wason 1974).
4 Making a management decision. The outcome of the clinical decision-making
process involves the health professional deciding on the way forward. Weinman
(1987) suggested that it is important to realize that the outcome of a consultation and
a diagnosis is not an absolute entity, but is itself a hypothesis and an informed guess
that will be either confirmed or refuted by future events.
Explaining variability
Variability in the behaviour of health professionals can therefore be understood in terms
of the processes involved in clinical decisions. For example, health professionals may:
I access different information about the patient’s symptoms;
I develop different hypotheses;
I access different attributes either to confirm or to refute their hypotheses;
I have differing degrees of a bias towards confirmation;
I consequently reach different management decisions.
Explaining variability – the role of health professionals’
health beliefs
The hypothesis testing model of clinical decision making provides some understanding
of the possible causes of variability in health professional behaviour. Perhaps the most
important stage in the model that may lead to variability is the development of the
original hypothesis. Patients are described as having lay beliefs, which are individual and
variable. Health professionals are usually described as having professional beliefs, which
are often assumed to be consistent and predictable. However, the development of the
original hypothesis involves the health professional’s own health beliefs, which may vary
as much as those of the patient. Components of models such as the health belief model,
the protection motivation theory and attribution theory have been developed to examine
health professionals’ beliefs. The beliefs involved in making the original hypothesis can be
categorized as follows:
1 The health professional’s own beliefs about the nature of clinical problems.
Health professionals have their own beliefs about health and illness. This pre-existing
factor will influence their choice of hypothesis. For example, if a health professional
believes that health and illness are determined by biomedical factors (e.g. lesions,
bacteria, viruses) then they will develop a hypothesis about the patient’s problem that
reflects this perspective (e.g. a patient who reports feeling tired all the time may be
anaemic). However, a health professional who views health and illness as relating to
psychosocial factors may develop hypotheses reflecting this perspective (e.g. a patient
who reports feeling tired all the time may be under stress).
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2 The health professional’s estimate of the probability of the hypothesis and
disease. Health professionals will have pre-existing beliefs about the prevalence and
incidence of any given health problem that will influence the process of developing
a hypothesis. For example, some doctors may regard childhood asthma as a common
complaint and hypothesize that a child presenting with a cough has asthma, whereas
others may believe that childhood asthma is rare and so will not consider this
hypothesis.
3 The seriousness and treatability of the disease. Weinman (1987) argued that
health professionals are motivated to consider the ‘pay-off’ involved in reaching a
correct diagnosis and that this will influence their choice of hypothesis. He suggested
that this pay-off is related to their beliefs about the seriousness and treatability of an
illness. For example, a child presenting with abdominal pain may result in an original
hypothesis of appendicitis as this is both a serious and treatable condition, and the
benefits of arriving at the correct diagnosis for this condition far outweigh the costs
involved (such as time-wasting) if this hypothesis is refuted. Marteau and Baum
(1984) have argued that health professionals vary in their perceptions of the seriousness of diabetes and that these beliefs will influence their recommendations for
treatment. Brewin (1984) carried out a study looking at the relationship between
medical students’ perceptions of the controllability of a patient’s life events and the
hypothetical prescription of antidepressants. The results showed that the students
reported variability in their beliefs about the controllability of life events; if the patient
was seen not to be in control (i.e. the patient was seen as a victim), the students were
more likely to prescribe antidepressants than if the patient was seen to be in control.
This suggests that not only do health professionals report inconsistency and
variability in their beliefs, this variability may be translated into variability in their
behaviour.
4 Personal knowledge of the patient. The original hypothesis will also be related to
the health professional’s existing knowledge of the patient. Such factors may include
the patient’s medical history, knowledge about their psychological state, an understanding of their psychosocial environment and a belief about why the patient uses
the medical services.
5 The health professional’s stereotypes. Stereotypes are sometimes seen as
problematic and as confounding the decision-making process. However, most meetings between health professionals and patients are time-limited and consequently
stereotypes play a central role in developing and testing a hypothesis and reaching a
management decision. Stereotypes reflect the process of ‘cognitive economy’ and may
be developed according to a multitude of factors such as how the patient looks/talks/
walks or whether they remind the health professional of previous patients. Without
stereotypes, consultations between health professionals and patients would be
extremely time-consuming.
Other factors which may influence the development of the original hypothesis include:
1 The health professional’s mood. The health professional’s mood may influence the
choice of hypotheses and the subsequent process of testing this hypothesis. Isen et al.
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