Can Medical Diagnosis Benefit from "Unconscious Thought"?

Med Decis Making. 2016 May;36(4):541-9. doi: 10.1177/0272989X15581352. Epub 2015 Apr 7.


The unconscious thought theory argues that making complex decisions after a period of distraction can lead to better decision quality than deciding either immediately or after conscious deliberation. Two studies have tested this unconscious thought effect (UTE) in clinical diagnosis with conflicting results. The studies used different methodologies and had methodological weaknesses. We attempted to replicate the UTE in medical diagnosis by providing favorable conditions for the effect while maintaining ecological validity. Family physicians (N= 116) diagnosed 3 complex cases in 1 of 3 thinking modes: immediate, unconscious (UT), and conscious (CT). Cases were divided into short sentences, which were presented briefly and sequentially on computer. After each case presentation, the immediate response group gave a diagnosis, the UT group performed a 2-back distraction task for 3 min before giving a diagnosis, and the CT group could take as long as necessary before giving a diagnosis. We found no differences in diagnostic accuracy between groups (P= 0.95). The CT group took a median of 7 s to diagnose, which suggests that physicians were able to diagnose "online," as information was being presented. The lack of a difference between the immediate and UT groups suggests that the distraction had no additional effect on performance. To assess the decisiveness of the evidence of this null result, we computed a Bayes factor (BF01) for the 2 comparisons of interest. We found a BF01of 5.76 for the UT versus immediate comparison and of 3.61 for the UT versus CT comparison. Both BFs provide substantial evidence in favor of the null hypothesis: physicians' diagnoses made after distraction are no better than diagnoses made either immediately or after self-paced deliberation.

Keywords: Bayes factor; clinical reasoning; deliberation without attention; dual processes; family medicine; unconscious thought effect.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Bayes Theorem
  • Clinical Decision-Making / methods*
  • Diagnosis*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Models, Psychological
  • Physicians, Family / psychology*
  • Reproducibility of Results
  • Unconscious, Psychology*