The semantics of diagnosis and management of genitourinary infections: a cross-specialty study

To investigate agreement between physicians about diagnosis and management concepts of genitourinary infection, data from 63 symptomatic women was collected and distributed to a panel consisting of three general practitioners, three urologists and three nephrologists. Using double-blind methods, the panel was asked individually to give a preliminary diagnosis and a management recommendation for each case. Pairwise comparison of the evaluations showed 66% agreement for diagnosis and 79% agreement for prescription of antibiotics. Adjusting for chance agreement, the kappa index was 0.43 for prescription of antibiotics, 0.31 for diagnosis of cystitis, 0.20 for vulvovaginitis, 0.21 for pyelonephritis and 0.09 for urethritis. The specialist groups ordered significantly more laboratory investigations, resulting in a 75-95% more expensive work-up compared with general practitioners. The findings imply a need for more distinct use of the concept of 'urethritis' and are consistent with previously demonstrated differences in resource use between general practitioners and specialist physicians.