To determine if physician specialty, length of time in practice, and fear of malpractice influence the diagnosis and management of breast cancer in older women.
We used a fractional factorial design that controlled for patient age (65 or 80 years), race, socioeconomic status, mobility, comorbidity, and assertive behavior through 2 videotaped scenarios (a potential breast cancer [no. 1] and a known stage IIA breast cancer [no. 2]). One hundred twenty-eight white male physicians equally divided by specialty (surgeon versus nonsurgeon) and time in practice (¾15 or>15 years) viewed the videotapes and made recommendations.
The physician subjects saw 46 patients per week, 59% female, and 47% age =65.
Their concern over malpractice was 4.7 (on a 10-point Likert scale with a higher score indicating more concern) and did not differ by specialty or time in practice (P values>0.7).
After viewing scenario no. 1, surgeons were less likely than nonsurgeons to consider breast cancer as the principal diagnosis (odds ratio [OR]=0.4,95% confidence interval [Cl]=0.2 to 0.9) and to obtain a tissue diagnosis (OR=0.3,95% Cl=0.1 to 0.9).
However, in scenario no. 2, surgeons were more likely to offer reconstruction (OR=3.8,95% Cl=1.4 to 10.4).
Physicians in practice ¾15 years were more likely than those in practice<15 years to obtain a tissue diagnosis in scenario no. 1 (OR=6.1,95% Cl=1.9 to 19.2) and to perform full primary therapy in scenario no. 2 (OR=2. (...)
Mots-clés Pascal : Tumeur maligne, Glande mammaire, Médecin, Spécialité médicale, Expérience professionnelle, Pratique professionnelle, Faute professionnelle, Diagnostic, Traitement, Vieillard, Homme, Femelle, Etude comparative, Etats Unis, Amérique du Nord, Amérique, Glande mammaire pathologie, Personnel sanitaire
Mots-clés Pascal anglais : Malignant tumor, Mammary gland, Physician, Medical specialty, Professional experience, Professional practice, Malpractice, Diagnosis, Treatment, Elderly, Human, Female, Comparative study, United States, North America, America, Mammary gland diseases, Health staff
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0006789
Code Inist : 002B20E02. Création : 17/04/1998.