Physicians, Probabilities, and Populations-Estimating the Likelihood of Disease for Common Clinical Scenarios
| العنوان: | Physicians, Probabilities, and Populations-Estimating the Likelihood of Disease for Common Clinical Scenarios |
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| المؤلفون: | Arjun K. Manrai |
| المصدر: | JAMA Internal Medicine |
| سنة النشر: | 2021 |
| مصطلحات موضوعية: | medicine.medical_specialty, Myocardial ischemia, business.industry, Research, Bayesian probability, Clinical reasoning, Disease, medicine.disease, Pneumonia, Text mining, Physicians, Internal Medicine, Medicine, Humans, Online First, Less Is More, business, Intensive care medicine, Probability, Original Investigation |
| الوصف: | Key Points Question Do practitioners understand the probability of common clinical diagnoses? Findings In this survey study of 553 practitioners performing primary care, respondents overestimated the probability of diagnosis before and after testing. This posttest overestimation was associated with consistent overestimates of pretest probability and overestimates of disease after specific diagnostic test results. Meaning These findings suggest that many practitioners are unaccustomed to using probability in diagnosis and clinical practice. Widespread overestimates of the probability of disease likely contribute to overdiagnosis and overuse. Importance Accurate diagnosis is essential to proper patient care. Objective To explore practitioner understanding of diagnostic reasoning. Design, Setting, and Participants In this survey study, 723 practitioners at outpatient clinics in 8 US states were asked to estimate the probability of disease for 4 scenarios common in primary care (pneumonia, cardiac ischemia, breast cancer screening, and urinary tract infection) and the association of positive and negative test results with disease probability from June 1, 2018, to November 26, 2019. Of these practitioners, 585 responded to the survey, and 553 answered all of the questions. An expert panel developed the survey and determined correct responses based on literature review. Results A total of 553 (290 resident physicians, 202 attending physicians, and 61 nurse practitioners and physician assistants) of 723 practitioners (76.5%) fully completed the survey (median age, 32 years; interquartile range, 29-44 years; 293 female [53.0%]; 296 [53.5%] White). Pretest probability was overestimated in all scenarios. Probabilities of disease after positive results were overestimated as follows: pneumonia after positive radiology results, 95% (evidence range, 46%-65%; comparison P This survey study of physicians, nurse practitioners, and physician assistants explores practitioner understanding of diagnostic reasoning. |
| تدمد: | 2168-6114 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::028218770c873046aae1eecf08cc1b82 https://pubmed.ncbi.nlm.nih.gov/33818595 |
| Rights: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....028218770c873046aae1eecf08cc1b82 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 21686114 |
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