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Related Experiment Videos

How do physicians weigh iatrogenic complications?

B J Cohen1, S G Pauker

  • 1Department of Medicine, New England Medical Center, Tufts University School of Medicine, Boston, MA.

Journal of General Internal Medicine
|January 1, 1994
PubMed
Summary

Physicians sometimes weigh potential harm from medical errors (commission) more heavily than harm from untreated conditions (omission). This finding helps explain variations in clinical practice regarding iatrogenic complications.

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Area of Science:

  • Clinical Decision-Making
  • Medical Ethics
  • Patient Safety

Background:

  • Physicians face complex decisions balancing treatment benefits against risks.
  • Iatrogenic complications, or harm caused by medical treatment, are a significant concern in healthcare.
  • Understanding how physicians perceive and weigh these risks is crucial for improving patient outcomes.

Purpose of the Study:

  • To investigate how physicians evaluate iatrogenic complications when making clinical decisions.
  • To quantify the relative importance physicians assign to errors of commission versus errors of omission.

Main Methods:

  • A questionnaire-based study involving staff physicians from an academic medical center.
  • Physicians were presented with clinical scenarios involving natural adverse outcomes and indistinguishable iatrogenic adverse outcomes.

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  • Respondents indicated the probability thresholds at which they considered treatment and withholding treatment to be equivalent strategies.

    • Main Results:

    • 56% of physicians assigned more weight to errors of commission (iatrogenic harm) than errors of omission (untreated harm).
    • The mean ratio of iatrogenic probability to natural probability (PI/PN) was 0.53 when commission errors were weighted more heavily.
    • This indicates a tendency for some physicians to avoid iatrogenic harm even when the risk is lower than the natural adverse outcome.

    Conclusions:

    • Physician attitudes towards weighing commission versus omission errors vary.
    • This variability in risk perception may contribute to observed differences in clinical practice.
    • Addressing these differing attitudes could help standardize care and reduce iatrogenic complications.