Influence of Familiar Features on Diagnosis: Instantiated Features in an Applied Setting

Medical diagnosis can be viewed as a categorization task. There are two mechanisms whereby humans make categorical judgments: "analytical reasoning," based on explicit consideration of features and "nonanalytical reasoning," an unconscious holistic process of matching against prior exemplars. However, there is evidence that prior experience can also operate at the level of individual "instantiated" features (Brooks & Hannah, 2006). The present studies examined instantiated features in medical diagnosis. Four "pseudopsychiatric" conditions, each described by four characteristic features, were taught to undergraduate psychology students. They practiced on additional cases, then were tested on new cases with features from two conditions. In Experiment 1, diagnoses associated with familiar features presented one or three times during practice were assigned a higher probability than those with novel features. Experiment 2 showed that the impact of feature frequency was dependent on its consistency with the case diagnosis. Experiment 3 showed that the effect of feature familiarity was not confined to cases with two equiprobable diagnoses. Experiment 4 showed that the effect remained after a 24 hour delay. These four studies demonstrated that features seen in practice have a greater influence on diagnosis than novel synonyms. In fact, seeing a feature once within the appropriate context (a patient case in which it is a member of the primary diagnosis) was sufficient to form a diagnostic association equivalent to instantiations seen four times in a different context. The results of these studies have implications for theories of categorization and for teaching clinical reasoning.