How doctors make differential diagnosis: a functional Magnetic Resonance Imaging (fMRI) study

• Grant number: 19/15060-5
• Support Opportunities: Regular Research Grants
• Start date: October 01, 2020
• End date: March 31, 2024
• Field of knowledge: Health Sciences - Medicine
• Principal Investigator: Edson Amaro Junior
• Grantee: Edson Amaro Junior
• Host Institution: Instituto Israelita de Ensino e Pesquisa Albert Einstein (IIEPAE). Sociedade Beneficente Israelita Brasileira Albert Einstein (SBIBAE). São Paulo , SP, Brazil
• Associated researchers: Helio Arthur Bacha ; Marcio Antonio dos Santos Melo

Abstract

This research project is a continuity of our research theme on the brain mechanisms involved in medical diagnosis. The evocation of differential diagnosis during medical assessment is critical for the accuracy of the final diagnosis. Understanding the neurocognitive mechanisms of this process may contribute to the development of methods to reduce diagnostic errors. In this research protocol, we will investigate the neural mechanisms engaged in differential diagnosis employing fMRI and pupillometry, a marker of central noradrenergic activity. The core of the experimental design is the presentation of sequences of written diagnostic information, 'mini clinical vignettes', to internal medicine physicians who will vocalize the diagnoses being evoked during an fMRI session, in parallel with the data collection of pupillometric responses. Vignettes with information consistent with one target diagnosis and vignettes in which the data is compatible with two different diagnoses will be utilized. It will be a bilingual study, in Portuguese and in English, where the data of 20 Brazilian participants will be collected in São Paulo, and 20 North-American participants in Boston, USA. Our central hypothesis is that the neural network involved in the lexical semantic processing of the diagnostic information which enables the evocation of medical diagnoses, including differential diagnosis, is modulated by neural networks involved in attention and conflict monitoring. We proposed that this modulation is regulated by the specificity of the diagnostic information and by the eventual conflict between the diagnostic hypotheses evoked, therefore, being related to the uncertainty regarding the final diagnosis. (AU)