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Relation of Physicians' Predicted Probabilities of Pneumonia to Their Utilities for Ordering Chest X-rays to Detect Pneumonia

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  • Paul S. Heckerling
  • Thomas G. Tape
  • Robert S. Wigton

Abstract

To investigate the relation between physicians' predicted probabilities of pneumonia and their utilities for ordering chest x-rays to detect pneumonia, the authors studied 52 physicians who ordered chest x-rays of 886 patients presenting to an emergency department with fever or respiratory complaints Physicians estimated the probability of pneumonia prior to obtaining the results of the chest x-ray. Utilities were assessed by asking physicians to consider a hypothetical patient presenting with acute respiratory symptoms, with unknown chest x-ray status, and to rank on a scale from +50 ("best thing I could do") to - 50 ("worst thing I could do") their rating scale utilities for not diagnosing pneumonia and not ordering a chest x-ray when the patient had pneumonia (i.e, missing a pneumonia), and for diagnosing pneumonia and ordering a chest x-ray when the patient did not have pneumonia (i.e, ordering an unnecessary x-ray) The utility for ordering an unnecessary x-ray was negatively correlated with average predicted probability (r = -0 1495, p = 0 29), whereas the utility for missing a pneumonia was positively correlated with average predicted probability (r = 0 2254, p = 0.11), although the correlations were not statistically significant. Relative chagrin, defined as the difference in these utilities, was significantly inversely correlated with average predicted probability (r = -0 2992, p

Suggested Citation

  • Paul S. Heckerling & Thomas G. Tape & Robert S. Wigton, 1992. "Relation of Physicians' Predicted Probabilities of Pneumonia to Their Utilities for Ordering Chest X-rays to Detect Pneumonia," Medical Decision Making, , vol. 12(1), pages 32-38, February.
    • Handle: RePEc:sae:medema:v:12:y:1992:i:1:p:32-38
    DOI: 10.1177/0272989X9201200106
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    References listed on IDEAS

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    1. Arnold M. Epstein & Barbara J. McNeil, 1985. "Physician Characteristics and Organizational Factors Influencing Use of Ambulatory Tests," Medical Decision Making, , vol. 5(4), pages 401-415, December.
    2. Stephen D. Nightingale, 1987. "Risk Preference and Laboratory Use," Medical Decision Making, , vol. 7(3), pages 168-172, August.
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    1. Davis, Elizabeth B. & Ashton, Robert H., 2002. "Threshold adjustment in response to asymmetric loss functions: The case of auditors' "substantial doubt" thresholds," Organizational Behavior and Human Decision Processes, Elsevier, vol. 89(2), pages 1082-1099, November.

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