The impact of reading a clinical study on treatment decisions of physicians and residents.
The study presented here reports on the impact of newly published clinical research on physicians' decisions. Eighty-three pediatricians, pediatric residents, and family practitioners were presented with a common, potentially serious problem, an infant with a high fever, and were required to estimate the probabilities of bacteremia and of acquiring meningitis and to choose from management options. The participants then read a published scientific report addressing the risks of meningitis in febrile infants and were asked afterward to answer again the questions relating to the clinical problem. After reading the study, the participants significantly increased their probability estimates of the patient acquiring meningitis. Only 14 percent of the participants would have hospitalized the patient before reading the article, but 47 percent would have done so after reading the article. Pediatricians were more likely than family practitioners to use antibiotics after reading the article. These decisions were not based not based on logical processing of information, as there was no correlation between the physicians' estimate of the risk of meningitis and the underlying risk of bacteremia and no correlation between the participants' decisions to hospitalize or use antibiotics and their estimated risk of the patient developing meningitis. Physicians appear to have considerable difficulty in using probability data and appear to base estimates of serious disease and subsequent management on intuition rather than calculation.
Bergman
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Pantell
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D002140:California; D004502:Education, Medical, Continuing; D006801:Humans; D007231:Infant, Newborn; D007396:Internship and Residency; D008091:Literature; D008581:Meningitis / Q000175:diagnosis / Q000628:therapy; D010820:Physicians; D010821:Physicians, Family; D012306:Risk; D018805:Sepsis / Q000175:diagnosis / Q000628:therapy