Chaput de Saintonge D M, Hattersley L A
Fam Pract. 1985 Dec;2(4):205-12. doi: 10.1093/fampra/2.4.205.
Wide variations in antibiotic prescribing for otitis media have suggested the need to discover the causes of the differences and help doctors reach agreement. Simulated cases--in the form of written clinical data extracts based on real patients--were used to study the diagnostic and prescribing behaviour of a group of six general practitioners. Clinical judgement analysis was used to model the way in which doctors diagnosed otitis media and their policy for using antibiotics. Most doctors performed consistently and their judgements could be fitted well to models using a small number of symptoms and signs. These models often differed from the policy they believed they were operating. This information was used as process feedback in a group discussion to help improve agreement within the practice on the management of otitis media. Some of the variation in behaviour observed at the start of the study was reduced by significant changes in that of the trainee. Other doctors changed little and some were sceptical of the validity of the experimental methods. The prospects for and difficulties of this type of analysis are discussed.
中耳炎抗生素处方存在很大差异，这表明有必要找出差异的原因，并帮助医生达成共识。以基于真实患者的书面临床数据摘录形式呈现的模拟病例，被用于研究一组六名全科医生的诊断和处方行为。临床判断分析被用于模拟医生诊断中耳炎的方式及其使用抗生素的策略。大多数医生的表现较为一致，他们的判断能够很好地拟合使用少量症状和体征的模型。这些模型往往与他们认为自己所采用的策略不同。这些信息在小组讨论中用作过程反馈，以帮助该诊所内部在中耳炎治疗管理上提高一致性。研究开始时观察到的一些行为差异，因实习医生行为的显著变化而有所减少。其他医生变化不大，一些人对实验方法的有效性表示怀疑。本文讨论了这类分析的前景和困难。
