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Does choosing a treatment depend on making a diagnosis? US and French physicians' decision making about acute otitis
Paul Clay Sorum1, Thomas R Stewart, Etienne Mullet
1Department of Medicine, Albany Medical Center, New York, USA. sorump@mail.amc.edu
Background:
The classic sequential processing model of clinical decision making-in which the treatment choice follows and depends on the diagnostic judgment-may in some cases be replaced by a processing model in which the treatment choice depends on an independent assessment of the diagnostic and other cues. The aim of this study was to determine which processing model would better describe physicians' treatment choices in a simulated clinical task.
Methods:
Seventy-five US and French primary care physicians were presented twice, in a different order, with the same set of 46 scenarios of 15-month-old children suspected of having acute otitis media (AOM). They rated in one set the probability of AOM and in the other set whether they would treat the child with antibiotics (and how confident they felt in their decision). Linear regression analyses revealed the individuals' 2 judgment policies. Hierarchical discriminant analysis was used to analyze the variance explained in the treatment choice by, 1st, the diagnostic judgment, 2nd, the cues specific to treatment, and 3rd, the cues specific to diagnosis.
Results:
Even when choosing treatment, the participants placed greatest weight on diagnostic cues, especially the ear findings. Only 28% used the cues that reflected parental issues. For 36%, the diagnostic cues had an effect on the treatment choice independent of the effect (if any) of the diagnostic judgment.
Conclusion:
In deciding how to treat AOM, the majority of the participating US and French primary care physicians followed the classic sequential processing model, but a substantial minority used instead an independent processing model.