Comparative analysis of diagnostic probability estimates of some common diagnoses among family doctors, medical residents, and medical students reveals negative correlation between age and estimate of chronic obstructive pulmonary disease (COPD)
Peter Vajer, Agnes Szelvari, Krisztian Voros, Peter Torzsa, Ajandek Eory, Klaudia Dunai, Ferenc Tamas, Laszlo Kalabay
Med Sci Monit 2010; 16(3): CR109-115
Available online: 2010-02-26
Patients with their given complaints and symptoms expect certain diagnoses to be estimated with the same probability when seen by different family doctors. These estimations showed extreme variation among family doctors in Switzerland. The present study investigated whether there is any difference in the probabilities of the same diagnoses given by Hungarian doctors and, if so, what the responsible factors are. Estimates given by specialists, residents of family medicine, and medical students were also compared.
Material and Method: In this cross-sectional study, 484 family physicians, 124 medical residents, and 148 medical students completed a questionnaire that assessed the diagnostic probability of six clinical scenarios.
Results: Medians and ranges of probability were almost the same in both countries. Significant negative correlation was observed between age and the estimation of COPD among the family physicians (Spearman's r=-0.231, p<0.001). This correlation was even more expressed in men and was independent of gender, previous specialization in internal medicine or pulmonology, and the location of practice. Family physicians rated the probability of myocardial infarction higher than the residents (p<0.01). They also rated the probability of congestive heart disease higher than the medical students (p<0.001). Women residents and students gave higher estimates in almost all clinical settings than did men.
Conclusions: Diagnostic estimates of the same clinical scenarios vary widely among Hungarian family doctors, residents, and medical students. The independent inverse relationship between the doctor's age and his/her estimate of the probability of COPD underscores the need to intensify education on this disease.
Keywords: Sex Characteristics, Pulmonary Disease, Chronic Obstructive - diagnosis, Physicians, Family, Probability, Internship and Residency, Logistic Models, Internal Medicine, Hungary, Education, Medical, Graduate, Age Factors, Adult, Switzerland, Time Factors, young adult