Prostate Tests; Diagnosis, Treatment of Otitis Media
I have been involved for the past two years in a logistically difficult Brunswikian study comparing diagnostic judgments of acute otitis media (of its probability) and treatment choices (whether or not to prescribe antibiotics) among U.S. family practitioners, French pediatricians and general practitioners, U.S. parents, and French parents.
My collaborators have included Tom Stewart and Junseop Shim in Albany (Junseop did most of the analyses) and Etienne Mullet, Gerard Chasseigne, and Maria Teresa Munoz Sastre in Tours, France.
I presented most of the major findings at the Boulder meeting and am slowly completing an article for submission to the others and then to a journal.
The six major findings of the otitis study were:
1. The large disagreement in diagnostic judgments and treatment choices within physician groups, but not among them;
2. The wide variation in internal consistency of individual physicians;
3. The reliance on the physical exam of the ear;
4. The similarity of the parents to the physicians in their decision making, even if they differed in many attitudes and opinions;
5. The participants' lack of insight into their judgment policies; and
6. The lack of impact of personal attitudes and opinions, except for a concern about fever, on the propensity to treat with antibiotics.
Our next project is to study decision making about the prostate. The specific issue-of importance in France as well as in the U.S-is why physicians order prostatic antigen tests even though this is discouraged by medical authorities in both countries.
Junseop has already done some work on it, and one of Etienne's students is also ready to go.