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Medical decision making and perceived socioeconomic class
G E Kikano1, M A Schiaffino, S J Zyzanski
1Department of Family Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
Archives of Family Medicine
|May 1, 1996
Summary
Physician awareness of patient socioeconomic status influenced clinical decisions, increasing follow-up frequency but not necessarily the number of tests ordered. This impacts healthcare delivery and patient management strategies.
Area of Science:
- Medical Ethics
- Health Services Research
- Clinical Decision Making
Background:
- Physician clinical decision-making may be influenced by patient socioeconomic status (SES) and profession.
- Previous research suggests a correlation between perceived patient SES and diagnostic testing intensity.
Purpose of the Study:
- To investigate the impact of physician knowledge of patient socioeconomic status or profession on clinical decision-making in an outpatient setting.
Main Methods:
- A survey was distributed to general internists, family practitioners, and general practitioners.
- Physicians received simulated clinical scenarios with or without patient socioeconomic status/profession information.
- Outcomes measured included diagnostic test ordering and follow-up visit scheduling.
Main Results:
- No significant difference in tests ordered for scenario 1; scenario 2 showed more tests ordered when patient SES/profession was known (P = .03).
- Physicians scheduled earlier follow-up visits when patient SES/profession was disclosed in both scenarios (P = .01).
- Results did not fully align with prior studies on test ordering and perceived patient SES.
Conclusions:
- Physician knowledge of patient socioeconomic status or profession can increase the intensity of follow-up care.
- The study did not find a consistent increase in diagnostic test ordering based on perceived patient SES.
- Clinical decision-making is complex and may be influenced by factors beyond diagnostic necessity.