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An International Comparison of Physicians' Judgments of Outcome Rates of Cardiac Procedures and Attitudes toward Risk, Uncertainty, Justifiability, and Regret

Author

Listed:
  • Roy M. Poses
  • D. Mark Chaput De Saintonge
  • Donna K. Mcclish
  • Wally R. Smith
  • Elizabeth C. Huber
  • F. Lynne W. Clemo
  • Brian P. Schmitt
  • Donna Alexander-Forti
  • Edward M. Racht
  • Christopher C. Colenda III
  • Robert M. Centor III

Abstract

Objective. Compare U.K. and U.S. physicians' judgments of population probabilities of important outcomes of invasive cardiac procedures; and values held by them about risk, uncertainty, regret, and justifiability relevant to utilization of cardiac treatments. Design. Cross-sectional study. Setting. University hospital and VA medical center in the United States; two teaching hospitals in the United Kingdom. Participants. 171 housestaff and attendings at U.S. teaching hospitals; 51 physician trainees and consultants at U.K. hospitals. Measures. Judgments of probabilities of severe complications and deaths due to Swan-Ganz catheterization, cardiac catheterization, percutaneous transluminal coronary angioplasty (PTCA), and coronary artery bypass grafting (CABG); judgments of malpractice risks for case vignettes; Nightingale's risk-aversion instrument; Gerrity's reaction-to-uncertainty instrument; questions about need to justify decisions; responses to case vignettes regarding regret. Results. The U.S. physicians judged rates of two bad outcomes of cardiac procedures (complications due to cardiac catheterization; death due to CABG) to be significantly higher (p ≤ 0.01) than did the U.K. physicians (U.S. medians, 5 and 3.5, respectively; U.K. medians 3 and 2). The median ratio of (risk of malpractice suit I error of omission)/(risk of suit I error of commission) judged by U.K. physicians, 3, was significantly (p = 0.0006) higher than that judged by U.S. physicians, 1.5. The U.K. physicians were less often risk-seeking in the context of possible losses than the U.S. physicians (odds ratio for practicing in the U.K. as a predictor of risk seeking 0.3, p = 0.003). The U.K. physicians had significantly more discomfort with uncertainty than did the U.S. physicians, as reflected by higher scores on the stress scale (U.K. median 48, U.S. 42, p = 0.0001) and the reluctance-to-disclose-uncertainty scale (U.K. 40, U.S. 37, p

Suggested Citation

  • Roy M. Poses & D. Mark Chaput De Saintonge & Donna K. Mcclish & Wally R. Smith & Elizabeth C. Huber & F. Lynne W. Clemo & Brian P. Schmitt & Donna Alexander-Forti & Edward M. Racht & Christopher C. Co, 1998. "An International Comparison of Physicians' Judgments of Outcome Rates of Cardiac Procedures and Attitudes toward Risk, Uncertainty, Justifiability, and Regret," Medical Decision Making, , vol. 18(2), pages 131-140.
    • Handle: RePEc:sae:medema:v:18:y:1998:i:2:p:131-140
    DOI: 10.1177/0272989X9801800201
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