How do physicians weigh iatrogenic complications?

Abstract

Objective: To determine how physicians weigh iatrogenic complications when making clinical decisions.

Design: Physicians were mailed a questionnaire describing two simplified scenarios—one involving a patient with a cerebral embolism and the other involving a patient with a life-threatening arrhythmia. In each scenario there was one potential natural adverse outcome (which could be prevented with drug therapy) and one potential drug side effect (iatrogenic adverse outcome), which would be clinically indistinguishable from the natural adverse outcome. Half the respondents were given the probability of the natural adverse outcome (P_N) and were asked to specify the probability of the iatrogenic adverse outcome (P₁) at which they felt that giving and withholding the therapy were equivalent strategies. The other respondents were given the P, and asked to specify the P_N at which they felt the two strategies were equivalent.

Setting: Academic medical center.

Participants: Staff physicians.

Measurements and main results: Results are expressed as the ratio P₁/P_N at which the respondent felt that giving and not giving therapy were equivalent strategies. A ratio less than 1 indicates that errors of commission (iatrogenic adverse outcomes) were given more weight than were errors of omission (natural adverse outcomes when therapy was withheld). Ratios less than 1 were provided in 56% of the responses (n=230). The mean P₁/P_N in the group with ratios less than 1 was 0.53±0.26 (SD;n=129).

Conclusions: In making decisions, some physicians appear to weigh errors of commission more heavily than they do errors of omission, while others weigh them equally. This diversity of physicians’ attitudes may explain some of the variation observed in clinical practice in settings where the possibility of iatrogenic complications is of concern.

Key words|iatrogenic complications|medical decision making|physicians