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:
access different information about the patient’s symptoms;
develop different hypotheses;
access different attributes either to confirm or to refute their hypotheses;
have differing degrees of a bias towards confirmation;
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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