This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Sorum, P. C. Articles by Grenier, B. Search for Related Content PubMed PubMed Citation Articles by Sorum, P. C. Articles by Grenier, B. Social Bookmarking                         What's this?

Does Choosing a Treatment Depend on Making a Diagnosis? US and French Physicians’ Decision Making about Acute Otitis Media

Departments of Medicine and Pediatrics, Albany Medical Center, Albany, New York

Thomas R. Stewart, PhD

Center for Policy Research, University of Albany, Albany, New York

Etienne Mullet, PhD

École Pratique des Hautes Études, Toulouse, France

Claudia González-Vallejo, PhD

Department of Psychology, Ohio University, Athens, Ohio

Junseop Shim, PhD

Center for Policy Research, University of Albany, Albany, New York

Gérard Chasseigne, PhD

Département de Psychologie, Université François-Rabelais, Tours, France

María Teresa Muñoz Sastre, PhD

Département de Psychologie, Université du Mirail, Toulouse, France

Bernard Grenier, MD

Faculté de Médecine, Tours, France

Background. The classic sequential processing model of clinical decision making—in which the treatment choice follows and depends on the diagnostic judgment—may in some cases be replaced by a processing model in which the treatment choice depends on an independent assessment of the diagnostic and other cues. The aim of this study was to determine which processing model would better describe physicians’ treatment choices in a simulated clinical task.Methods. Seventy-five US and French primary care physicians were presented twice, in a different order, with the same set of 46 scenarios of 15-month-old children suspected of having acute otitis media (AOM). They rated in one set the probability of AOM and in the other set whether they would treat the child with antibiotics (and how confident they felt in their decision). Linear regression analyses revealed the individuals’ 2 judgment policies. Hierarchical discriminant analysis was used to analyze the variance explained in the treatment choice by, 1st, the diagnostic judgment, 2nd, the cues specific to treatment, and 3rd, the cues specific to diagnosis.Results. Even when choosing treatment, the participants placed greatest weight on diagnostic cues, especially the ear findings. Only 28% used the cues that reflected parental issues. For 36%, the diagnostic cues had an effect on the treatment choice independent of the effect (if any) of the diagnostic judgment. Conclusion. In deciding how to treat AOM, the majority of the participating US and French primary care physicians followed the classic sequential processing model, but a substantial minority used instead an independent processing model.

Key Words: decision making • judgment analysis • acute otitis media

Medical Decision Making, Vol. 22, No. 5, 394-402 (2002)
DOI: 10.1177/027298902236941


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				J Ubachs-Moust, R Houtepen, R Vos, and R ter Meulen Value judgements in the decision-making process for the elderly patient J. Med. Ethics, December 1, 2008; 34(12): 863 - 868. [Abstract] [Full Text] [PDF]

				T. Fischer, S. Fischer, W. Himmel, M. M. Kochen, and E. Hummers-Pradier Family Practitioners' Diagnostic Decision-Making Processes Regarding Patients with Respiratory Tract Infections: An Observational Study Med Decis Making, November 1, 2008; 28(6): 810 - 818. [Abstract] [PDF]