Family Practitioners' Diagnostic Decision-Making Processes Regarding Patients with Respiratory Tract Infections: An Observational Study

Abstract

FPs tended to make their diagnosis based on a few patient symptoms and a limited physical examination. Simple heuristic models were almost as powerful in explaining most diagnoses as saturated models. Direct observation allowed for the study of decision making under real conditions, yielding both quantitative data and "qualitative'' information about the FPs' performance. It is important for investigators to be aware of the specific disadvantages of the method (e.g., a possible observer effect).

Clinical influences on antibiotic prescribing decisions for lower respiratory tract infection: a nine country qualitative study of variation in care

“…Chest auscultation was the most consistently mentioned examination procedure used to guide decisions, a finding in keeping with previous research 8 15 16 19 20 and with the GRACE-01 observational study conducted within these same networks where auscultation was performed on 99% (n=2690) of the patients who attended with symptoms of acute cough. Clinicians reported listening for a wide variety of auscultationary abnormalities, implying a lack of consistency in identifying and interpreting findings.…”

“…This fits with Atkinson's notion of diagnosis as professional detective work or a ‘puzzle-solving activity’ 28. However, Fischer et al 16 found that family practitioners performed a ‘simplified process’, in line with simple heuristics that led to a decision to prescribe antibiotics (or not). For some clinicians, decision making was clearly not a process in which the various factors are taken and considered in a step-by-step manner.…”

“…15 However, that study was limited to one region in Belgium and did not provide an in-depth description of the multiple components which make up clinical method. Fischer and colleagues16 conducted a direct observational study of family practitioners' decision making for patients with RTI in Germany but did not provide information on the process and ordering of clinical factors. Furthermore, there are no large qualitative studies that offer a wider European comparison.…”

Converting habits of antibiotic prescribing for respiratory tract infections in German primary care – the cluster-randomized controlled CHANGE-2 trial

“…With an average prescription rate of 50%, in German primary care antibiotics are still too frequently prescribed for respiratory tract infections (RTI) [1,2]. Even among children, prescription of antibiotics by general practitioners (GPs) and pediatricians is extensive [3], although it is recognized that antibiotics are very unlikely to alter the course of RTI, such as throat infections, acute otitis media, maxillary sinusitis, and acute bronchitis [4,5].…”

“…During consultations patients often express their worries about symptoms and desire reassurance about the harmlessness of their medical condition. Quite often this perceived pressure leads to unnecessary prescriptions of antibiotics [2,13,15,19-21]. Receiving antibiotics in turn reinforces patients’ beliefs that antibiotics are powerful agents against uncomplicated RTI and strengthens the assumption that future RTI should be treated equally [4,22].…”