In seven judgement situations, the GP was uncertain about the diagnosis.
Each of the 15 GPs judged 6 case vignettes, which resulted in 90 judgement situations.
However, in a third of the judgement situations, no information about echocardiography was utilized in the general practitioners' diagnostic reasoning.
In three judgement situations, the final diagnosis was in the same direction as the X-ray argument (three CHF).
In our study, the GPs used other diseases as an argument in a total of 70 judgement situations, mostly as arguments for CHF (91%).
However, in more than one third of the judgement situations, the information about ECHO that was presented was not used as an argument.
While paper cases have the advantage of ease of administration [ 10, 11], their ability to evoke judgements that are similar to clinicians' responses to actual judgement situations is questionable [ 12- 14].
(CHF = chronic heart failure, CV = case vignette, GP = general practitioner) In 17 judgement situations, there was a conflict between the GPs' evaluations of the chest X-ray information and their evaluations of the ECHO information.
In some of the judgement situations in which the EF value was not used as an argument, other ECHO information was utilized, such as left ventricular hypertrophy or restricted motility of the ventricular wall.
Table 3 shows the use of ECHO in all the judgement situations: Five GPs used information about EF in their diagnostic reasoning for five of the case vignettes, four GPs used it for four of the vignettes, one GP used it for three of the vignettes, one GP for two of the vignettes and two GPs for one of the vignettes (and in one case in the wrong direction).
