Clinician personality and the evaluation of higher-risk patient symptoms

: Acute myocardial infarction, breast cancer, and colorectal cancer are among the most commonly misdiagnosed conditions in primary care, and there is little information regarding physician decision making in this area.

: We measured clinician risk tolerance and stress from uncertainty among 193 primary care clinicians and determined their association with management of patients presenting with chest pain (n = 700), breast lumps (n = 630), or rectal bleeding (n = 470). We used the 6-item Jackson Personality Inventory (JPI) and the 13-item Stress from Uncertainty Scale (SUS). Extended evaluation was defined as performance of electrocardiogram, cardiac stress testing, or emergency department triage for patients with chest pain; mammography, ultrasound, or surgical referral for patients with breast lumps; and colonoscopy or gastroenterology referral for patients with rectal bleeding. We fit multivariable logistic regression models to determine the association between survey scores and performance of extended evaluation.

: The response rate was 79% for the JPI survey and 73% for the SUS survey. The mean JPI score was 8.9 (SD, 4.5) and the mean SUS score was 32.6 (SD, 10.4). Extended evaluation occurred for 60% of patients with chest pain, 93% of patients with breast lumps, and 63% of patients with rectal bleeding. Scores in JPI and SUS were not associated with rates of extended evaluation.

: Primary care clinician risk tolerance and stress from uncertainty were not associated with evaluation decisions. Future research is needed to improve the consistency of evaluations to improve ambulatory patient safety.