Physician personality factors do not seem to influence whether patients with symptoms undergo extended diagnostic evaluations
Research Activities, April 2012
A primary care clinician's degree of risk tolerance and stress from uncertainty do not affect whether patients with possible symptoms of heart attack, breast cancer, or colorectal cancer undergo extended clinical evaluation, a new study finds. These three conditions are among the most commonly misdiagnosed in primary care, often leading to delay in proper treatment. The researchers collected information on attitudes towards risk taking and uncertainty-related stress from 193 clinicians (62 percent physicians and 38 percent nurse practitioners or physician assistants) and how the clinicians handled 700 patients complaining of chest pain, 630 seen because of a breast lump, and 470 seen for rectal bleeding.
After adjusting for relevant demographic and clinical factors, neither of the clinician's personality factors was associated with their patients receiving an extended clinical evaluation. Nearly half (49 percent) of the patients seen for chest pain received extended examinations, as did 93 percent of those seen for breast lumps and 63 percent of patients seen for rectal bleeding. The researchers conducted the study in a large, multispecialty group practice in eastern Massachusetts, whose 15 ambulatory health centers used the same electronic health record. All primary care physicians in the group practice were surveyed in 2008 about attitudes towards risk taking and in 2009 about degree of stress felt from uncertainty. The researchers assessed the correlation between extended clinical examination and composite scores on the two surveys. The study was funded in part by the Agency for Healthcare Research and Quality (HS17075).
More details are in "Clinician personality and the evaluation of higher-risk patient symptoms," by Adrienne S. Allen, M.D., Endel John Orav, Ph.D., Thomas H. Lee, M.D., and others in the September 2011 Journal of Patient Safety 7(3), pp. 122-126.