Special ArticleAcademic Calculations versus Clinical Judgments: Practicing Physicians’ Use of Quantitative Measures of Test Accuracy 1
Section snippets
Definitions for Diagnostic and Test Accuracy
In this report, diagnostic accuracy is defined as the ability of a test to correctly predict the presence of a particular disease among patients with positive test results, and to indicate absence of the disease among patients with negative results. Test accuracy, in contrast, is defined by other quantitative expressions, which include sensitivity (ie, proportion of diseased patients with positive test results), specificity (proportion of nondiseased patients with negative test results), and
Results
Of the 333 physicians contacted by telephone, 302 (91%) agreed to participate. Two physicians were interviewed but promptly excluded because they reported not enough time (<40%) in direct patient care. The 31 physicians who declined to participate said they were too busy (17), not interested (9), or did not do phone surveys (5). Participation rates for the six medical specialties ranged from 89% (SIM) to 96% (GIM).
The 300 participating physicians had a median age of 46, were predominantly male
Discussion
The results of this survey indicate that practicing physicians seldom use the recommended formal methods for diagnostic evaluations. Fewer than 25% of the surveyed physicians considered sensitivity and specificity values before ordering tests in clinical practice; and the recommended transformational methods, which require formal calculations to estimate the probability of disease (or nondisease), were almost never used. The Bayesian transformation approach, which is the most widely advocated
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This work was done when Drs. Reid and Lane were fellows in the Robert Wood Johnson Scholars Program at Yale.
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Dr. Lane’s current address is Department of Primary Care, Navy Medical Center, San Diego California.