Differences Between Internists and Family Practitioners in the Diagnosis and Management of the Same Patient With Coronary Heart Disease

Abstract

It has been suggested that internists and family practitioners have somewhat different “disease” perspectives, which may be generated by use of different explanatory models during medical training (pathophysiological vs. biopsychosocial, respectively). This paper explores differences between internists and family practitioners in their suggested diagnoses, level of diagnostic certainty, test and prescription ordering, when encountering exactly the same “patient” with coronary heart disease (CHD). Internists were more certain of a CHD diagnosis than family practitioners and were more likely to act on this diagnosis. Family practitioners were more likely to diagnose (and were more certain of) a mental health condition. While many physicians simultaneously entertain several alternate diagnoses, diagnostic certainty has shown to have an important influence on subsequent clinical actions such as stress testing and prescription of beta blockers. These results may inform future educational strategies designed to reduce diagnostic uncertainty in the face of life-threatening conditions, like CHD.

Physician Styles of Patient Management as a Potential Source of Disparities: Cluster Analysis from a Factorial Experiment

“…This literature generally seeks to understand well‐documented patterns wherein physicians make different diagnostic and treatment decisions based on nonmedical factors, including patient characteristics (such as race, gender, age, socioeconomic status) (Arber et al. ), but also providers' individual attributes (gender, level of experience, specialty, place of training) (Shackelton‐Piccolo et al ) and the characteristics of the health care settings in which they work, such as practice culture (Kralewski et al. ,b), work stress (Siegrist et al.…”

“…strategies (Institute of Medicine 2001Icks et al 2007) increasingly turning to provider decision making as one potential contributor to observed health disparities. This literature generally seeks to understand well-documented patterns wherein physicians make different diagnostic and treatment decisions based on nonmedical factors, including patient characteristics (such as race, gender, age, socioeconomic status) ), but also providers' individual attributes (gender, level of experience, specialty, place of training) (Shackelton-Piccolo et al 2011) and the characteristics of the health care settings in which they work, such as practice culture (Kralewski et al 2005a,b), work stress (Siegrist et al 2010), presence of health information technology (Ketcham et al 2009), and country (von dem Knesebeck et al 2008). In some cases, this variation amounts to differences in quality as measured by health care processes, such as whether a patient receives a specific test (e.g., hemoglobin A1c) or meets guideline criteria (e.g., average glucose or lipid levels).…”

Social Foundations of Health Care Inequality and Treatment Bias

“…Given observed patterns in health behaviors, utilization, and access to care, we know that patients are not randomly distributed among providers. However, even in vignette factorial experiments wherein physicians are randomized to patients, individual physician characteristics such as gender, specialty, and level of experience are robust predictors of differences in clinical diagnostic and treatment decisions (McKinlay et al 2002, Shackelton-Piccolo et al 2011. By extension, patient-provider race concordance has been associated with positive health outcomes and patient satisfaction (Kumar et al 2009, Malat 2001, Meghani et al 2009.…”

Procedures performed by general practitioners and general internal medicine physicians - a comparison based on routine data from Northern Germany

“…However, according to previous studies, procedures differ considerably between GPs and GIM physicians, e.g. regarding the use of diagnostics [ 6 ], medical charges [ 7 ], prescribing [ 8 ], communication [ 9 ], provision of care for patients with common conditions [ 10 ], range of specific health needs covered [ 11 ] and patient outcomes [ 12 ].…”