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Robert A. Greenberg, MD; Edward H. Wagner, MD, MPH; Susanne H. Wolf, RN, MPH; Steven B. Cohen, PhD; David G. Kleinbaum, PhD; Carolyn A. Williams, PhD; Michel A. Ibrahim, MD, PhD

JAMA. 1978;240(7):650-653.

Abstract
To investigate the feasibility of establishing standards of care based on a broad consensus, a questionnaire concerning the management of signs and symptoms of common respiratory infections in infants was given to a national sample of pediatric infectious disease specialists, general pediatricians, and family physicians.

There was significant disagreement (P<.01) among the three groups of physicians in 15 of the 18 clinical situations concerning the appropriateness of prescribing antibiotics. Whenever there was disagreement, the family physician group was most inclined and the infectious disease group least inclined to favor antibiotic therapy. More than 75% of each group favored antibiotics in the same situation in only three instances. These results suggest that it may be difficult to set widely accepted standards for the evaluation of medical care where there are such differences of opinion.

(JAMA 240:650-653, 1978)

Author Affiliations
From the Department of Pediatrics (Dr Greenberg), School of Medicine, and the Departments of Epidemiology (Drs Wagner, Williams, and Ibrahim and Ms Wolf) and Biostatistics (Drs Cohen and Kleinbaum), School of Public Health, University of North Carolina at Chapel Hill.

Footnotes
Reprint requests to Department of Pediatrics, Clinical Sciences Bldg 229H, University of North Carolina School of Medicine, Chapel Hill, NC 27514 (Dr Greenberg).

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