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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
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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.

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.