How do physicians weigh iatrogenic complications?

To determine how physicians weigh iatrogenic complications when making clinical decisions. Physicians were mailed a questionnaire describing two simplified scenarios--one involving a patient with a cerebral embolism and the other involving a patient with a life-threatening arrhythmia. In each scenar...

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Bibliographic Details
Published in:Journal of general internal medicine 1994, Vol.9 (1), p.20-23
Main Authors: COHEN, B. J, PAUKER, S. G
Format: Article
Language:English
Subjects:
Anti-Arrhythmia Agents - adverse effects
Anti-Arrhythmia Agents - therapeutic use
Anticoagulants - adverse effects
Anticoagulants - therapeutic use
Arrhythmias, Cardiac - drug therapy
Attitude of Health Personnel
Biological and medical sciences
Boston
Decision Making
Humans
Iatrogenic Disease
Intracranial Embolism and Thrombosis - drug therapy
Medical sciences
Medical Staff, Hospital - psychology
Miscellaneous
Pharmacology. Drug treatments
Probability
Surveys and Questionnaires
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Summary:To determine how physicians weigh iatrogenic complications when making clinical decisions. Physicians were mailed a questionnaire describing two simplified scenarios--one involving a patient with a cerebral embolism and the other involving a patient with a life-threatening arrhythmia. In each scenario there was one potential natural adverse outcome (which could be prevented with drug therapy) and one potential drug side effect (iatrogenic adverse outcome), which would be clinically indistinguishable from the natural adverse outcome. Half the respondents were given the probability of the natural adverse outcome (PN) and were asked to specify the probability of the iatrogenic adverse outcome (PI) at which they felt that giving and withholding the therapy were equivalent strategies. The other respondents were given the PI and asked to specify the PN at which they felt the two strategies were equivalent. Academic medical center. Staff physicians. Results are expressed as the ratio PI/PN at which the respondent felt that giving and not giving therapy were equivalent strategies. A ratio less than 1 indicates that errors of commission (iatrogenic adverse outcomes) were given more weight than were errors of omission (natural adverse outcomes when therapy was withheld). Ratios less than 1 were provided in 56% of the responses (n = 230). The mean PI/PN in the group with ratios less than 1 was 0.53 +/- 0.26 (SD; n = 129). In making decisions, some physicians appear to weigh errors of commission more heavily than they do errors of omission, while others weigh them equally. This diversity of physicians' attitudes may explain some of the variation observed in clinical practice in settings where The possibility of iatrogenic complications is of concern.
ISSN:0884-8734
1525-1497
DOI:10.1007/BF02599137