Abstract
Understanding the brain mechanisms involved in diagnostic reasoning may contribute to the development of methods that reduce errors in medical practice. In this study we identified similar brain systems for diagnosing diseases, prescribing treatments, and naming animals and objects using written information as stimuli. Employing time resolved modeling of blood oxygen level dependent (BOLD) responses enabled time resolved (400 milliseconds epochs) analyses. With this approach it was possible to study neural processes during successive stages of decision making. Our results showed that highly diagnostic information, reducing uncertainty about the diagnosis, decreased monitoring activity in the frontoparietal attentional network and may contribute to premature diagnostic closure, an important cause of diagnostic errors. We observed an unexpected and remarkable switch of BOLD activity within a right lateralized set of brain regions related to awareness and auditory monitoring at the point of responding. We propose that this neurophysiological response is the neural substrate of awareness of one’s own (verbal) response. Our results highlight the intimate relation between attentional mechanisms, uncertainty, and decision making and may assist the advance of approaches to prevent premature diagnostic closure.
Highlights
Understanding the brain mechanisms involved in the diagnosis of diseases – and prescription of medical treatments – may contribute to the development of methods that improve diagnostic accuracy and reduce errors in medical practice
Our results show that activity in the frontoparietal attentional network (FPAN) was modulated by the salience of the information presented, with low diagnosticity stimuli evoking greater responses
The same pattern of blood oxygen level dependent (BOLD) response was observed when tested under different tasks (Supplementary Fig. S1)
Summary
Understanding the brain mechanisms involved in the diagnosis of diseases – and prescription of medical treatments – may contribute to the development of methods that improve diagnostic accuracy and reduce errors in medical practice. We previously demonstrated that the diagnosis of radiological lesions engages neural systems very similar to those involved in naming animals[1] We test this hypothesis in the verbal domain, using textual sequences of diagnostic information. The most utilized methodology to investigate clinical reasoning has been clinical vignettes - short written descriptions of medical problems - followed by questions to be answered by participants[9] In this experimental paradigm, each trial lasts for dozens of seconds; frequently for more than a minute[10,11,12,13]. The relatively long duration of the task trials using this paradigm creates special challenges for modelling the neural processes involved in diagnostic reasoning To meet these demands, we employed a reductionistic approach, using an experimental design in which only key information needed to accomplish the tasks was conveyed by the stimuli
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