Additional Investigations and Referrals by Primary Care Physicians in Uncertain Clinical Situations: Cross-Sectional...

Area of Science:

• Medical Education
• Clinical Decision Making
• Health Services Research

Background:

• Uncertainty is common in primary care, potentially impacting physician decisions for investigations and referrals.
• Physician experience, anxiety, and reaction to uncertainty influence ordering practices.
• Previous studies lacked standardized conditions for evaluating these factors.

Purpose of the Study:

• To investigate the association between physician experience and the ordering of additional investigations and referrals in uncertain clinical scenarios.
• To utilize a standardized virtual patient simulation to assess decision-making processes.

Main Methods:

• A cross-sectional study involving 40 physicians, stratified by experience (<10 vs ≥10 years).
• Participants encountered a standardized virtual patient simulation with diagnostic uncertainty.
• Data collected included physician characteristics, anxiety scores (STAI-Y), reaction to uncertainty, and orders for investigations/referrals, analyzed via multivariate regression.

Main Results:

• Physicians with less experience (<10 years) reported higher anxiety and reaction to uncertainty scores.
• Less experienced physicians ordered more investigations and referrals (10.2 vs 8.1), though this was not statistically significant in multivariate analysis.
• Multivariate analysis linked investigation/referral orders to physician age and anxiety scores, not years of experience.

Conclusions:

• Less experienced physicians do not excessively rely on additional investigations, indicating preserved clinical reasoning skills.
• Interventions targeting physician anxiety and tolerance for uncertainty may influence ordering practices.
• Training for supervisors and virtual consultations could enhance uncertainty management in medical education.