"Optimal" cost-effectiveness analyses?
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Acquired Immunodeficiency Syndrome↗
Biomedical subjects
S D Nightingale
Publications and source records attributed to S D Nightingale.
Risk preference and laboratory use.
One hundred thirty-seven physicians were asked to choose between a certain loss of five years of life expectancy and a 50/50 gamble of losing either ten years or zero years of life expectancy. These choices were presented as hypothetical options for a patient with cancer. The 46 who chose the certain loss ordered 23% fewer laboratory tests/patient visit in our General Medicine Clinic over an eight-week period than those who chose the gamble (p less than 0.05). This risk preference was further stratified by sequentially offering five, four, three, two, and one years of certain loss against the same 50/50 gamble of ten or zero years of loss; greater preference for the gamble correlated with greater laboratory use (p less than 0.002). To exclude physician knowledge or case mix as a cause of this result, this risk preference was correlated with total score, and with the cost of tests ordered in patient management problems, of 49 physician on the American Board of Internal Medicine Certifying Examination. Cost of tests ordered was 23% less for the 17 who chose the certain loss (p less than 0.001); total score did not vary with risk preferences. There was no association between risk preference in the face of gain and laboratory use, and none between an individual's risk preferences in the face of gain and in the face of loss. The cognitive processes that determine risk preference in the face of loss, whatever they may be, appear to have a substantial influence on physician test-ordering behavior.
Clinical Laboratory Techniques↗
Psychological androgyny and preference for intubation in a hypothetical case of end-stage lung disease.
Psychological androgyny theory (PAT) was employed as a model of the interpersonal (social) and task activities required of physicians for care of their patients. According to PAT, individuals with a large repertoire of task and social skills ("androgynous" individuals) should be optimally adaptable to contingencies reflecting varying combinations of task and social challenges. The authors examined the relationship between androgyny and preference for intubation on a patient management problem involving end-stage lung disease for 67 general internists and internal medicine housestaff from two hospitals. Results revealed a negative relationship between androgyny and preference for intubation, suggesting that androgynous and nonandrogynous physicians respond differently to complex and difficult decision-making tasks. Indirect evidence is offered to suggest that this response reflects a general tendency to utilize fewer health care resources. Discussion focuses on the need to improve the precision of measurement of these latent constructs.
Extraversion, Psychological↗
Psychological androgyny and preference in loss-framed gambles of medical students: possible implications for resource utilization.
Physician decisions concerning allocation of health care resources to patients are highly variable and poorly understood. Psychological androgyny theory (PAT) has been employed as a model of the interpersonal and task activities required of physicians for care of their patients. Several studies have successfully predicted physician resource utilization using measures derived from PAT. Using a sample of 97 first-year medical students, the authors explored the relationship between PAT and risk preference in loss-framed gambles in order to elucidate the process whereby variables derived from PAT predict resource utilization. As hypothesized, students selecting the certain loss had significantly higher mean androgyny scores than did students selecting uncertainty. Research involving these constructs is integrated in the context of a theoretical "causal model," which highlights issues deserving of future research.
Choice Behavior↗
Sympathy, empathy, and physician resource utilization.
OBJECTIVE: To test the hypothesis that physicians preferring a sympathetic over an empathetic response to a hypothetical patient's misfortune will utilize more health care resources in the care of their patients. DESIGN: Physicians were asked to select either the sympathetic response or the empathetic response to a hypothetical patient's misfortune (death of a spouse) and to state their preferences for intubation of a hypothetical end-stage lung-disease patient. For each physician, hospital records were retrospectively reviewed to assess the mean number of laboratory tests ordered per clinic patient and the mean duration of cardiopulmonary resuscitations he or she performed before declaring his or her efforts unsuccessful. SETTING: General medicine clinic at a large urban hospital. PARTICIPANTS: 101 physicians above the postgraduate year-I level who attended the general medicine clinic. MEASUREMENTS AND MAIN RESULTS: As hypothesized, physicians selecting the sympathetic option (n = 58) had a greater mean preference for intubation (p less than 0.02), ordered more laboratory tests per patient in clinic (p less than 0.03), and performed cardiopulmonary resuscitation for longer periods of time before declaring their efforts unsuccessful (p less than 0.06) than did physicians selecting the empathetic option (n = 38). CONCLUSIONS: These data suggest that the constructs of sympathy and empathy reflect psychological aspects of physicians that have a measurable influence on their practice behaviors.
Attitude of Health Personnel↗