Surgeons Have an Implicit Preference for Specific Disease Over Nonspecific Illness

Area of Science:

• Orthopedic Surgery
• Medical Psychology
• Health Services Research

Background:

• Nonspecific illnesses lack measurable pathology and can carry social stigma.
• This stigma may bias healthcare providers towards diagnosing specific diseases, potentially leading to overdiagnosis and overtreatment.

Purpose of the Study:

• To investigate factors associated with surgeons' implicit and explicit preferences for specific diseases over nonspecific illnesses.
• To determine the relationship between surgeons' implicit and explicit preferences.

Main Methods:

• A survey-based experiment involving 103 surgeons from the Science of Variation Group.
• Utilized an Implicit Associations Test (IAT) to assess implicit bias and numerical ratings for explicit preferences.
• Employed multivariable linear regression and Spearman correlation to analyze the data.

Main Results:

• A notable implicit bias favoring specific diseases over nonspecific illness was observed (median 70).
• No clinically significant explicit preference was found between specific disease and nonspecific illness (median 8).
• No correlation was found between implicit and explicit preferences (Spearman r = -0.13).

Conclusions:

• An implicit bias exists among musculoskeletal specialists towards specific diseases, potentially influencing diagnostic testing and labeling.
• Clinicians and patients can mitigate overtesting and overtreatment by acknowledging this bias and focusing on objective pathophysiology.