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Implications for Decision Making

Roy M. Poses, MD; Randall D. Cebul, MD; Marjeanne Collins, MD; Samuel S. Fager, MD

JAMA. 1985;254(7):925-929.

Abstract
Ten physicians recorded their treatment decisions and estimated probabilities of streptococcal infection for patients with sore throats. Of 308 throat cultures, 15 (4.9%) were positive for group A streptococci. The physicians overestimated the probability of a positive culture for 81% of their patients and their estimates and treatment decisions were strongly associated. Of 104 patients treated before culture results were available, only eight had positive cultures. Probability overestimation may have been due to (1) neglect of the low culture-positive rate, (2) assignment of undue importance to weakly predictive or highly intercorrelated clinical features, and (3) a value-induced bias, occurring when features important for treatment are erroneously linked to the likelihood of disease. Cognitive limitations in information processing may limit the effectiveness of pharyngitis management protocols that require subjective estimates of disease probability.

(JAMA 1985;254:925-929)

Author Affiliations
From the Division of Internal Medicine, Department of Medicine, University of Medicine and Dentistry of New Jersey, Rutgers Medical School at Camden (Dr Poses); and the Section of General Medicine, Department of Medicine (Drs Cebul and Fager), and the Department of Pediatrics (Drs Collins and Fager), University of Pennsylvania School of Medicine, Philadelphia. Dr Fager is currently with the Department of Pediatrics, Cornell University School of Medicine, New York. Dr Poses performed this research, in part, as a Henry J. Kaiser Family Foundation Fellow in General Medicine at the University of Pennsylvania. Dr Cebul is a Henry J. Kaiser Family Foundation Faculty Scholar in General Medicine.

Footnotes
Reprint requests to 315R Nursing Education Bldg/S2, Section of General Medicine, Department of Medicine, University of Pennsylvania School of Medicine, 420 Service Dr, Philadelphia, PA 19104 (Dr Cebul).

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