Chest
Clinical InvestigationsVariability in Physician Estimates of Survival for Acute Respiratory Failure in Chronic Obstructive Pulmonary Disease
Section snippets
METHODS
I presented a patient-management problem modeled after the ABIM certification examination questions to a group of physicians. They were requested to select a limited amount of available case information, indicate a treatment preference (intubation vs allowing to die), estimate the patient’s survival time if treated, and explain the rationale for their treatment decision.
Subjects were 205 internal medicine and family medicine physicians in King County (WA). They either were affiliated with the
RESULTS
Two hundred five physicians participated in the study, including 72 resident physicians and 55 attending physicians at the University of Washington, and 78 private practitioners. Seventy-two physicians were from the family medicine discipline (18 resident physicians, 14 attending physicians, and 40 private practitioners). One hundred thirty three physicians were from the internal medicine discipline (54 resident physicians, 41 attending physicians, and 38 private practitioners).
The estimates
DISCUSSION
Physician estimates of survival were investigated because they are influential factors in medical decisions that involve the elderly or individuals near the end of life, and are often based on limited empirical data. As such, this represents an area of uncertainty that may be affected by professional or social values rather than “scientific” considerations.
A patient management problem describing an elderly, debilitated patient with chronic obstructive pulmonary disease and acute respiratory
ACKNOWLEDGMENTS
The author wishes to thank Drs. Daniel Kent and Thomas Martin for their careful review of the manuscript.
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This project was supported in part by the Veterans Administration Northwest Health Services Research and Development Field Program and Geriatric Research Education and Clinical Center, and the Robert Wood Johnson Foundation.
Manuscript received August 20; revision accepted October 14.