Access

You are not currently logged in.

Access your personal account or get JSTOR access through your library or other institution:

login

Log in to your personal account or through your institution.

The Unexpected Influence of Physician Attributes on Clinical Decisions: Results of an Experiment

John B. McKinlay, Ting Lin, Karen Freund and Mark Moskowitz
Journal of Health and Social Behavior
Vol. 43, No. 1 (Mar., 2002), pp. 92-106
Stable URL: http://www.jstor.org/stable/3090247
Page Count: 15
  • Download ($14.00)
  • Subscribe ($19.50)
  • Cite this Item
The Unexpected Influence of Physician Attributes on Clinical Decisions: Results of an Experiment
Preview not available

Abstract

This experiment was designed to determine: (1) whether patient attributes (specifically a patient's age, gender, race, and socioeconomic status) independently influence clinical decision-making; and (2) whether physician characteristics alone (such as their gender, age, race, and medical specialty), or in combination with patient attributes, influence medical decision-making. Methods. An experiment was conducted in which 16 (=24) videotapes portraying patient-physician encounters for two medical conditions (polymyalgia rheumatica (PMR) and depression) were randomly assigned to physicians for viewing. Each video presented a combination of four patient attributes (65 years or 80 years of age; male or female; black or white; blue or white collar occupation). Steps were taken to enhance external validity. One hundred twenty-eight eligible physicians were sampled from the northeastern United States, with numbers balanced across 16 (=24) strata generated from the following characteristics (male or female; $<15\;or \geq 15$ years since graduation; black or white; internists or family practitioners). The outcomes studied were: 1) the most likely diagnosis; 2) level of certainty adhering to that diagnosis; and 3) the number of tests that would be ordered. Results. Patient attributes (namely age, race, gender, and socioeconomic status) had no influence on the three outcomes studied (the most likely diagnosis, the level of certainty, and test ordering behavior). This was consistent across the two medical conditions portrayed (PMR and depression). In contrast, characteristics of physicians (namely their medical specialty, race, and age) interactively influenced medical decision-making. Conclusion. Epidemiologically important patient attributes (which Bayesian decision theorists hold should be influential) had no effect on medical decision-making for the two conditions, while clinically extraneous physician characteristics (which should not be influential) had a statistically significant effect. The validity of idealized theoretical approaches to medical decision making and the usefulness of further observational approaches are discussed.

Page Thumbnails

  • Thumbnail: Page 
92
    92
  • Thumbnail: Page 
93
    93
  • Thumbnail: Page 
94
    94
  • Thumbnail: Page 
95
    95
  • Thumbnail: Page 
96
    96
  • Thumbnail: Page 
97
    97
  • Thumbnail: Page 
98
    98
  • Thumbnail: Page 
99
    99
  • Thumbnail: Page 
100
    100
  • Thumbnail: Page 
101
    101
  • Thumbnail: Page 
102
    102
  • Thumbnail: Page 
103
    103
  • Thumbnail: Page 
104
    104
  • Thumbnail: Page 
105
    105
  • Thumbnail: Page 
106
    106