PAUL CLAY SORUM, MD, PHD JUNSEOP SHIM, MPA GÉRARD CHASSEIGNE, PHD ETIENNE MULLET, PHD MARIÍA TERESA MUÑOZ SASTRE, PHD THOMAS STEWART, PHD CLAUDIA GONZÁLEZ-VALLEJO, PHD Albany, New York; Tours, Bruxelles, and Toulouse, France; and Athens, Ohio Submitted, revised, May 29, 2001. From the departments of Medicine and Pediatrics, Albany Medical Center, Albany (P.C.S.); the Center for Policy Research, State University of New York-Albany (J.S., T.S.); the Département de Psychologie, Université François-Rabelais, Tours (G.C.); Ecole Pratique des Hautes Etudes (E.M.); the Département de Psychologie Clinique et Pathologique, Université du Mirail, Toulouse (M.T.M.S.); and the Department of Psychology, Ohio University, Athens (C.G.). Reprint requests should be addressed to Paul Clay Sorum, MD, Albany Med Primary Care Network, 724 Watervliet-Shaker Road, Latham, NY 12110. E-mail: sorump@mail.amc.edu.
OBJECTIVES: We wanted to discover how parents differ from physicians in making decisions about how to treat a child who may have acute otitis media (AOM).
STUDY DESIGN: We used questionnaires that required participants to judge the probability of AOM or choose treatment for 2 sets of 46 paper scenarios of hypothetical children aged 15 months who might have AOM, and they subsequently rated the importance of individual cues and described their attitudes and opinions related to health care and AOM.
POPULATION: Convenience samples of 19 US family physicians, 35 French generalists, 21 French pediatricians, 52 US parents, and 86 French parents were included.
OUTCOMES MEASURED: The primary outcomes were the judgment policies—the weights placed on each of the scenario cues when making decisions—that were derived for each individual and each group by multiple linear regression.
RESULTS: The mean judged probabilities of AOM were nearly the same for all groups: 50% for the US physicians, 51% for the US parents, 52.5% for the French physicians, and 52% for the French parents. The percentages of cases treated with antibiotics did not differ: 53% for US physicians, 45% for US parents, 53% for French physicians, and 51% for French parents. All groups gave greatest weight to the physical examination cues for decisions about both diagnosis and treatment. The parents paid little attention to the cues that reflected parental concerns.
CONCLUSIONS: US and French parents were very similar to physicians in their judgments and treatment choices regarding AOM. They appear to be able to adopt the physician’s point of view and to be selective in the use of antibiotics.
KEY POINTS FOR CLINICIANS
The appearance of the eardrum was the key factor in decision making about acute otitis media.
Both physicians and parents paid little attention to parental-sensitive factors when choosing treatment.
Parents were able to adopt the physician’s point of view.
Parents in the United States and France may be more willing to forgo antibiotics than physicians realize.
Acute otitis media (AOM) is the most frequent diagnosis for which antibiotics are prescribed in the United States1,2 and is among the most frequent in France.3 The benefit of antibiotic treatment is under scrutiny as physicians, parents, and policymakers in the United States,4-7 France,3,8-13 and elsewhere14-16 become increasingly worried about bacterial resistance to antibiotics.
Patients and caregivers often have a firm idea of what is wrong with their child and how it should be treated.17,18 Conflict with the physician may partially result from different interpretations that parents and physicians give to the same cues from the child’s history and physical examination, and the different implications derived from them. Despite evidence to the contrary,19-22 studies in the United States and Britain show that physicians feel parents are becoming increasingly demanding: They expect them to prescribe antibiotics even when they are not indicated and will be dissatisfied if they are not prescribed.22-29
The purpose of our study was to elucidate the differences between physicians and parents both in the United States and France by comparing their diagnostic judgments and treatment choices when dealing with children who might be suffering from AOM.
Methods
This study was primarily a “judgment analysis.”30 In judgment analyses, individuals make a series of judgments (eg, diagnoses or treatment choices about a series of patients) according to a set of varying cues (eg, signs and symptoms). Using multiple linear regression analyses, it is possible to determine how much weight they put on each cue when making their decisions. Separate regression analyses are performed for each person, with the cues as the predictors and the judgment (diagnoses or treatment decisions) as the variable predicted. The beta weights from the regression, suitably adjusted for differences in units of measurement, are estimates of the relative importance of the cues in making judgments. A higher beta weight for a cue indicates that it carried greater weight in making the diagnosis or treatment decision. Between- and within-group comparisons of these weights may reveal why people differ in their judgments of identical cases.
Participants
The samples consisted of 19 US family physicians, 35 French general practitioners, 21 French pediatricians, 52 US parents, and 86 French parents. The US physicians were recruited from the 62 family physicians in the region of Albany and Schenectady, New York, through written and oral appeals from the study team. The French practitioners consisted of personal contacts and members of 2 networks of research minded general practitioners. The French pediatricians were recruited by written appeals to the 30 practicing pediatricians in and around Tours, France. The US parents were responders to a recruitment letter sent to 100 randomly selected parents of young children of one primary care practice in suburban Albany. The French parents were recruited by students at the Université François-Rabelais in Tours.31
