Do Parents and Physicians Differ in Making Decisions About Acute Otitis Media?
Attitudes and opinions related to AOM and health care were not associated with the percentage of cases in which the participant of any group chose to treat with antibiotics. Among both the Americans and the French, the parents thought physicians worried more about charges of malpractice when making decisions about patient care than physicians claimed they did (P <.005 for both countries). Parents were bothered when their child was sick more than physicians were bothered when “one of my patients” was sick (P <.005 for both). If there was a possibility that their child had “a serious illness that is rare but curable,” parents were more willing than physicians to order diagnostic tests even when they would cost the parents “a great deal of time and/or money” (P <.005 for both). Interestingly, parents agreed less strongly than physicians with the statement “A doctor should pay close attention to the needs and preferences of a child’s parents” (P <.005 for both). US parents, but not those in France, agreed more strongly than physicians that if their child might have a serious illness that was rare but curable diagnostic tests should be ordered even when they were “very expensive for the child’s insurance plan” (P <.005). French parents, but not American ones, agreed more strongly than physicians that “all ear infections should be treated with antibiotics” (P <.005).
TABLE 1
DIFFERENCES AMONG GROUPS OF PARTICIPANTS
| US Physicians (n=19) | US Parents (n=52) | French Physicians (n=56) | French Parents (n=86) | |
|---|---|---|---|---|
| Mean judged probability of AOM (range) | 50 (28 to 75) | 51 (29 to 78) | 52.5 (33 to 85) | 52 (30 to 73) |
| Mean judged probability of treatment (range) | 0.22 (-2.4 to 3.0) | -0.32 (-2.7 to 3.1) | 0.36 (-1.5 to 3.0) | -0.42 (-2.9 to 2.6) |
| NOTE: The treatment score is the combination of the choice of observation versus antibiotics and the degree of certainty that this is the right choice, ranging from -5 (observe/completely sure) to 5 (antibiotics/completely sure). | ||||
| AOM denotes acute otitis media. | ||||
TABLE 2
MEAN BETA WEIGHTS FOR CUES FOR JUDGING PROBABILITY OF ACUTE OTITIS MEDIA
| Cue | US Physicians (n=19) | US Parents (n=52) | French Physicians (n=55) | French Parents (n=81) |
|---|---|---|---|---|
| History | ||||
| Past history of AOM | 0.02 | 0.08 | 0.03† | 0.15 |
| URI symptoms | 0.07 | -0.01 | 0 | 0.03 |
| Ear pain noted by parent | 0.09 | 0.07 | 0.04 | 0.04 |
| Findings on Examination | ||||
| Fever | 0.20 | 0.21 | 0.16† | 0.30† |
| Redness of tympanic membrane | 0.48* | 0.34* | 0.40 | 0.36 |
| Bulging of tympanic membrane | 0.25 | 0.31 | 0.48† | 0.17† |
| Mobility on insufflation | 0.37* | 0.22* | 0.13 | 0.14 |
| Asymmetry of tympanic membranes | 0.17* | 0.28* | 0.17 | 0.16 |
| Ear pain during examination | 0.09 | 0.14 | 0.09† | 0.28† |
| General appearance of the child | 0.08 | 0.06 | 0.02 | 0.06 |
| Did the child start to cry just before the examination? | 0.02 | -0.03 | -0.01 | -0.02 |
| Other Factors | ||||
| Parents’ personal position concerning antibiotics | -0.05 | 0.03 | 0.02 | 0.02 |
| Ability of parents to provide effective care to a sick child | 0.01 | -0.04 | -0.02 | -0.01 |
| Does caring for sick child greatly upset parents’ ordinary schedule? | 0 | 0.02 | 0 | 0.01 |
| Are there babies or other small children in the family? | 0 | 0.02 | 0 | 0.02 |
| Note: Higher values indicate a greater weight given to this cue in making the diagnosis of acute otitis media. Participants whose judgments failed to pass the F-test for multiple regression models (1 French pediatrician and 5 French parents) were excluded from the analysis. | ||||
| AOM denotes acute otitis media; URI, upper respiratory infection. | ||||
| *Significant comparison for US group, P <.05. | ||||
| †Significant comparison for French group, P <.05. | ||||
TABLE 3
MEAN BETA WEIGHTS FOR CUES FOR CHOOSING TREATMENT OF ACUTE OTITIS MEDIA
| Cue | US Physicians (n=19) | US Parents (n=49) | French Physicians (n=50) | French Parents (n=75) |
|---|---|---|---|---|
| History | ||||
| Past history of AOM | 0.02 | 0.04 | 0.04 | 0.08 |
| URI symptoms | 0.02 | 0.03 | 0.06 | 0.07 |
| Ear pain noted by parent | 0.11 | 0.10 | 0.07† | 0.0† |
| Findings on examination | ||||
| Fever | 0.21 | 0.28 | 0.25† | 0.52† |
| Redness of Tympanic membrane | 0.36 | 0.29 | 0.34† | 0.23† |
| Bulging of tympanic membrane | 0.19 | 0.23 | 0.41† | 0.08† |
| Mobility on insufflation | 0.28* | 0.16* | 0.12 | 0.10 |
| Asymmetry of tympanic membranes | 0.20 | 0.23 | 0.13 | 0.09 |
| Ear pain during examination | 0.04 | 0.11 | 0.04† | 0.14† |
| General appearance of the child | 0.16 | 0.10 | 0.10† | 0.04† |
| Did the child start to cry just before the examination? | 0.02 | 0 | 0.03 | 0 |
| Other factors | ||||
| Parents’ personal position concerning antibiotics | 0.17* | 0.06* | 0.11† | 0.03† |
| Ability of parents of provide effective care to a sick child | -0.05 | -0.03 | -0.05 | -0.04 |
| Does caring for sick child greatly upset parents’ ordinary schedule? | 0.01 | 0.04 | 0.01 | -0.08 |
| Are there babies or other small children in the family? | 0.01 | 0.04 | 0.04 | 0.01 |
| Note: Higher values indicate a greater weight given to this cue when deciding whether to treat with antibiotics. Participants whose judgments failed to pass the F-test for multiple regression models (3 French generalists, 3 French pediatricians, 3 US parents, and 11 French parents) were excluded from the analysis. | ||||
| AOM denotes acute otitis media; URI, upper respiratory infection. | ||||
| *Significant comparison for US group, P <.05. | ||||
| †Significant comparison for French group, P <.05. | ||||
Discussion
Although physicians are aware that antibiotic resistance of bacteria is an increasing problem,39-41 they continue to prescribe antibiotics for patients who are unlikely to benefit from them.2,3,13,39,42,43 There are multiple plausible reasons for this.7,17,44-46 Some of these relate to physicians’ perceptions of the wants and needs of their patients and their caretakers. Physicians may47 (or may not48) make different decisions for individuals they are dealing with than for community groups. They know the public misunderstands the indications for antibiotics,25,49,50 and they may perceive, often incorrectly,19,21 that patients or parents want antibiotics and will be dissatisfied if they do not receive them.22,23,26,29,45,51 They may practice defensive medicine28 or believe that it takes less time and effort to prescribe antibiotics than to explain why they are withholding them.28,45 They may be sensitive to the socioeconomic pressures on patients and parents related to daycare policies, work schedules, and the costs of return visits.46
