Antibiotic use in otitis media: patient simulations as an aid to audit

Diagnostic and prescribing practices in otitis media vary, and audit is difficult because doctors may not see comparable cases. Seven general practitioners took part in a pilot study to discover if simulated patients evoked the same diagnostic and treatment responses as reveal patients. Forty-eight patients entered the study over three weeks and provided data for two simulations; one included the doctor's description of the ear and the other a photograph instead. Each doctor was shown the two sets of simulations and asked to state his diagnosis and treatment. The diagnoses each doctor reached agreed significantly with those reached on the simulations of the same patients. The decisions to prescribe antibiotics also showed good agreement.