title: Impact of Patient Affect on Physician Estimate of Probability of Serious Illness and Test Ordering.
abstract: The authors hypothesize patient facial affect may influence clinician pretest probability (PTP) estimate of cardiopulmonary emergency (CPE) and desire to order a computerized tomographic pulmonary angiogram (CTPA).
  
  
  
  This prospective study was conducted at three Indiana University-affiliated hospitals in two parts: collecting videos of patients undergoing CTPA for suspected acute pulmonary embolism watching a humorous video (August 2014-April 2015) and presenting the medical histories and videos to clinicians to determine the impact of patient facial affect on physicians' PTP estimate of CPE and desire to order a CTPA (June-November 2015). Patient outcomes were adjudicated as CPE+ or CPE- by three independent reviewers. Physicians completed a standardized test of facial affect recognition, read standardized medical histories, then viewed videos of the patients' faces. Clinicians marked their PTP estimate of CPE and desire for a CTPA before and after seeing the video on a visual analog scale (VAS).
  
  
  
  Fifty physicians completed all 73 videos. Seeing the patient's face produced a > 10% absolute change in PTP estimate of CPE in 1,204/3,650 (33%) cases and desire for a CTPA in 1,095/3,650 (30%) cases. The mean area under the receiver operating characteristic curve for CPE estimate was 0.55 ± 0.15, and the change in CPE VAS was negatively correlated with physicians' standardized test scores (r = -0.23).
  
  
  
  Clinicians may use patients' faces to make clinically important inferences about presence of serious illness and need for diagnostic testing. However, these inferences may fail to align with actual patient outcomes.
authors.affiliation: J.A. Kline is professor and vice chair of research, Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana. D. Neumann is assistant professor, Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana. S. Raad is resident, Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana. D.L. Schriger is professor and vice chair, Department of Emergency Medicine, University of California, Los Angeles, Los Angeles, California. C.L. Hall is research manager, Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana. J. Capito is resident, Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana. D. Kammer is clinical associate professor, Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Kline
authors.forename: Dawn
authors.initials: D
authors.lastname: Neumann
authors.forename: Samih
authors.initials: S
authors.lastname: Raad
authors.forename: David L
authors.initials: DL
authors.lastname: Schriger
authors.forename: Cassandra L
authors.initials: CL
authors.lastname: Hall
authors.forename: Jake
authors.initials: J
authors.lastname: Capito
authors.forename: David
authors.initials: D
authors.lastname: Kammer
mesh_terms: D000328:Adult; D000339:Affect; D000072226:Computed Tomography Angiography; D004630:Emergencies; D004635:Emergency Medicine; D005149:Facial Expression; D005260:Female; D006333:Heart Failure / Q000175:diagnosis; D006801:Humans; D007388:Internal Medicine; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis; D010817:Physician-Patient Relations; D011014:Pneumonia / Q000175:diagnosis*; D011336:Probability; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000000981:diagnostic imaging*; D011655:Pulmonary Embolism / Q000175:diagnosis*; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000175:diagnosis*; D014741:Video Recording; D064232:Visual Analog Scale