Synapse
⌘+K
Synapse
PulseExploreClubsResearchersJournals
Instagram
HomeClubsExplore
March 10, 1997Archives of Internal Medicine

Differences in Clinical Decision Making Between Internists and Cardiologists

View Full Paper
Ask AI
Bookmark
Share

Key result

Cardiologists order ~106% more treadmill tests than internists for uncomplicated syncope.

  • 95% CI 10%-28%
  • n=916

Why the study?

Whether cardiologists or internists use discretionary tests differently for noncritical cardiological presentations was unclear.

Does clinical decision making and test ordering differ between cardiologists and internists for noncritical cardiological presentations?

Population

318 cardiologists and 598 internists responding to clinical scenarios

Comparison

Clinical decision making by cardiologists vs clinical decision making by internists

Design

Cross-sectional study

Authors

PGPeter Glassman

Discussion

Loading...

Member takes

Overview

Specialty differences in discretionary testing warrant caution in noncritical scenarios; leaves open whether cardiologist-led patterns improve outcomes or increase overutilization.

Study Design

Type

Cross-Sectional (n=916)

Structured PICO

Does clinical decision making and test ordering differ between cardiologists and internists for noncritical cardiological presentations?

P
Population
916 physicians (318 cardiologists and 598 internists) surveyed on clinical decision making for 3 common noncritical cardiological scenarios.
E
Exposure
Clinical decision making by cardiologists
C
Comparator
Clinical decision making by internists
O
Outcome
Management choice and test ordering for 3 common scenarios (uncomplicated syncope, nonanginal chest pain, and nonspecific electrocardiographic changes)

Main Result

Absolute Event Rate: 37% vs 18%

Cardiologists and internists differ substantially in discretionary test use for noncritical cardiology scenarios, with cardiologists focusing more on cardiological tests and internists on broader evaluations, though overall charges are similar.

Limitations

  • The potential effect on clinical outcomes is unknown.

Cite This Study

Peter Glassman (1997) conducted a cross-sectional in Noncritical cardiological presentations (n=916). Cardiologist specialty vs. Internist specialty was evaluated on Recommendation of exercise treadmill tests for uncomplicated syncope (95% CI 10%-28%). Cardiologists ordered more cardiological tests than internists for noncritical scenarios, such as exercise treadmill tests for uncomplicated syncope (37% vs 18%; 95% CI for difference 10%-28%).

synapsesocial.com/papers/6ab1ca3e5e56d22700de38afhttps://doi.org/10.1001/archinte.1997.00440260044008
View Full Paper
Ask AI
Bookmark
Share

Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Differences in Generalists' and Cardiologists' Perceptions of Cardiovascular Risk and the Outcomes of Preventive Therapy in Cardiovascular Disease1996 · 114 citations
  2. 2Value of the History and Physical in Identifying Patients at Increased Risk for Coronary Artery Disease1993 · 503 citations
  3. 3Evaluation and Management of the Patient With Syncope1992 · 229 citations
  4. 4Coefficient Alpha and the Internal Structure of Tests1951 · 44,034 citations
  5. 5Frequency and Costs of Diagnostic Imaging in Office Practice — A Comparison of Self-Referring and Radiologist-Referring Physicians1990 · 363 citations