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Related Experiment Videos

Differences in clinical decision making between internists and cardiologists

P A Glassman1, R L Kravitz, L P Petersen

  • 1Department of Medicine, Veterans Affairs Medical Center, Los Angeles, Calif, USA.

Archives of Internal Medicine
|March 10, 1997
PubMed
Summary

Cardiologists and internists order different diagnostic tests for noncritical heart conditions, though initial management and costs are similar. Cardiologists focus on cardiac tests, while internists consider a wider range of evaluations.

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Area of Science:

  • Cardiology
  • Internal Medicine
  • Clinical Decision-Making

Background:

  • The differential use of discretionary diagnostic tests by cardiologists versus internists for noncritical cardiac presentations remains unclear.
  • Understanding these differences is crucial for optimizing patient care and resource allocation.

Purpose of the Study:

  • To investigate disparities in the selection of diagnostic tests by cardiologists and internists across three common noncritical cardiology scenarios.
  • To compare management decisions, clinical risk estimations, and attitudes towards uncertainty, malpractice, and cost consciousness between the two physician groups.

Main Methods:

  • A survey was administered to 318 cardiologists and 598 internists, presenting three clinical scenarios: uncomplicated syncope, nonanginal chest pain, and nonspecific electrocardiographic changes.

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  • Participants were asked to outline patient management, estimate clinical risk, and respond to questions regarding practice influences.
  • Statistical analyses, including chi-squared tests, ANOVA, and t-tests, were employed to compare management choices and test ordering patterns. A 50% response rate was achieved.

    • Main Results:

    • While initial management decisions (admission, surgery timing) were comparable, subsequent diagnostic test utilization varied significantly between cardiologists and internists.
    • Cardiologists more frequently recommended specific cardiac diagnostic tests (e.g., exercise treadmill tests, signal-averaged electrocardiograms, thallium studies) compared to internists.
    • Internists were more inclined to order neurological tests for syncope, indicating a broader diagnostic approach, yet overall costs for diagnostic evaluations remained similar across both groups.

    Conclusions:

    • Significant differences exist in the discretionary diagnostic test selection between cardiologists and internists for noncritical cardiac presentations, with cardiologists favoring cardiac-specific tests and internists adopting a broader evaluation strategy.
    • Despite differing test preferences, the financial impact on diagnostic evaluation costs was comparable between the two specialties.
    • The clinical outcome implications of these distinct testing patterns warrant further investigation.