The influence of general and case-related experience on primary care treatment decision making.

In an effort to examine how general vs case-related clinical experience influenced physicians' treatment decisions, four clinical case vignettes (rheumatoid arthritis, fever of undetermined origin, exercise-induced asthma, and cor pulmonale) were presented to 387 primary care physicians. For each case, physicians indicated (1) their willingness to proceed with treatment without seeking additional information, (2) their preferences for sources of supplementary information, and (3) their preferences for continued care responsibility. The results indicated that the nature of the particular vignette had a major impact on how physicians made treatment decisions. Also, having greater case-related experience and being younger led to greater willingness to proceed with treatment and preferences for continued care responsibility. Preferences for information sources were largely independent of either form of experience. Treatment decision making appears to be quite dependent on experience with similar problems and being up-to-date on current treatment procedures.

[1]  L. Jacoby,et al.  Knowledge and clinical problem‐solving , 1985, Medical education.

[2]  Knowledge, realism, and diagnostic reasoning in a physical diagnosis course. , 1982, Journal of medical education.

[3]  Jay J.J. Christensen-Szalanski,et al.  Effects of expertise and experience on risk judgments. , 1983, The Journal of applied psychology.

[4]  Ellen J. Langer,et al.  When practice makes imperfect: debilitating effects of overlearning. , 1979 .

[5]  G. Gorry,et al.  Clinical problem solving: a behavioral analysis. , 1978, Annals of internal medicine.

[6]  V L Patel,et al.  Differences between medical students and doctors in memory for clinical cases , 1986, Medical education.

[7]  R. Boissoneau.  The impact of mandatory continuing education. , 1979, Hospital & health services administration.

[8]  Peter Burke,et al.  Log-linear models , 1980 .

[9]  L D Gruppen,et al.  Information-seeking strategies and differences among primary care physicians. , 1987, Mobius.

[10]  A E Voytovich,et al.  Premature conclusions in diagnostic reasoning. , 1985, Journal of medical education.

[11]  L. Shulman,et al.  Medical Problem Solving: An Analysis of Clinical Reasoning , 1978 .

[12]  H. Arkes,et al.  Impediments to accurate clinical judgment and possible ways to minimize their impact. , 1981, Journal of consulting and clinical psychology.

[13]  Michael J. Prietula,et al.  Expertise and error in diagnostic reasoning , 1981 .

[14]  P. Feltovich,et al.  The clinical reasoning process , 1987, Medical education.

[15]  C H McGuire,et al.  Medical problem-solving: a critique of the literature. , 1985, Journal of medical education.

[16]  Jay J.J. Christensen-Szalanski,et al.  Physicians' use of probabilistic information in a real clinical setting. , 1981 .

[17]  N Murray-Lyon.  Communication in medicine: a study of how family doctors obtain information on recent advances in the treatment of rheumatic diseases , 1977, Medical education.

[18]  V L Patel,et al.  Transfer of student learning in medical education. , 1983, Journal of medical education.

[19]  D E Northup,et al.  Characteristics of clinical information-searching: investigation using critical incident technique. , 1983, Journal of medical education.

[20]  Stephen E. Fienberg,et al.  The analysis of cross-classified categorical data , 1980 .