Greenberg R A, Wagner E H, Wolf S H, Cohen S B, Kleinbaum D G, Williams C A, Ibrahim M A
JAMA. 1978 Aug 18;240(7):650-3.
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 less than .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 antibiotics 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.
为了研究基于广泛共识制定护理标准的可行性，向全国范围内的儿科传染病专家、普通儿科医生和家庭医生样本发放了一份关于婴儿常见呼吸道感染体征和症状管理的调查问卷。在18种临床情况中的15种情况下，三组医生在是否适合使用抗生素的问题上存在显著分歧（p小于0.01）。每当出现分歧时，家庭医生组最倾向于使用抗生素，而传染病组最不倾向于使用抗生素。只有在三种情况下，每组超过75%的人在相同情况下赞成使用抗生素。这些结果表明，在存在如此多意见分歧的情况下，可能很难制定出被广泛接受的医疗护理评估标准。
