Impact of Patient Affect on Physician Estimate of Probability of Serious Illness and Test Ordering

Jeffrey Kline, Dawn Neumann, Samih Raad, David L. Schriger, Cassandra L. Hall, Jake Capito, David Kammer

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

PURPOSE: The authors hypothesize patient facial affect may influence clinician pretest probability (PTP) estimate of cardiopulmonary emergency (CPE) and desire to order a computerized tomographic pulmonary angiogram (CTPA). METHOD: This prospective study was conducted at three Indiana University–affiliated hospitals in two parts: collecting videos of patients undergoing CTPA for suspected acute pulmonary embolism watching a humorous video (August 2014–April 2015) and presenting the medical histories and videos to clinicians to determine the impact of patient facial affect on physicians’ PTP estimate of CPE and desire to order a CTPA (June–November 2015). Patient outcomes were adjudicated as CPE+ or CPE− by three independent reviewers. Physicians completed a standardized test of facial affect recognition, read standardized medical histories, then viewed videos of the patients’ faces. Clinicians marked their PTP estimate of CPE and desire for a CTPA before and after seeing the video on a visual analog scale (VAS). RESULTS: Fifty physicians completed all 73 videos. Seeing the patient’s face produced a > 10% absolute change in PTP estimate of CPE in 1,204/3,650 (33%) cases and desire for a CTPA in 1,095/3,650 (30%) cases. The mean area under the receiver operating characteristic curve for CPE estimate was 0.55 ± 0.15, and the change in CPE VAS was negatively correlated with physicians’ standardized test scores (r = −0.23). CONCLUSIONS: Clinicians may use patients’ faces to make clinically important inferences about presence of serious illness and need for diagnostic testing. However, these inferences may fail to align with actual patient outcomes.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

Original languageEnglish (US)
JournalAcademic Medicine
DOIs
StateAccepted/In press - Apr 11 2017

Fingerprint

Emergencies
illness
video
physician
Physicians
Angiography
Lung
Visual Analog Scale
open access
license
attribution
diagnostic
Licensure
recipient
Pulmonary Embolism
ROC Curve
Prospective Studies

ASJC Scopus subject areas

  • Medicine(all)
  • Education

Cite this

Impact of Patient Affect on Physician Estimate of Probability of Serious Illness and Test Ordering. / Kline, Jeffrey; Neumann, Dawn; Raad, Samih; Schriger, David L.; Hall, Cassandra L.; Capito, Jake; Kammer, David.

In: Academic Medicine, 11.04.2017.

Research output: Contribution to journalArticle

Kline, Jeffrey ; Neumann, Dawn ; Raad, Samih ; Schriger, David L. ; Hall, Cassandra L. ; Capito, Jake ; Kammer, David. / Impact of Patient Affect on Physician Estimate of Probability of Serious Illness and Test Ordering. In: Academic Medicine. 2017.
@article{32a6a094672d439da85626291f013e1b,
title = "Impact of Patient Affect on Physician Estimate of Probability of Serious Illness and Test Ordering",
abstract = "PURPOSE: The authors hypothesize patient facial affect may influence clinician pretest probability (PTP) estimate of cardiopulmonary emergency (CPE) and desire to order a computerized tomographic pulmonary angiogram (CTPA). METHOD: This prospective study was conducted at three Indiana University–affiliated hospitals in two parts: collecting videos of patients undergoing CTPA for suspected acute pulmonary embolism watching a humorous video (August 2014–April 2015) and presenting the medical histories and videos to clinicians to determine the impact of patient facial affect on physicians’ PTP estimate of CPE and desire to order a CTPA (June–November 2015). Patient outcomes were adjudicated as CPE+ or CPE− by three independent reviewers. Physicians completed a standardized test of facial affect recognition, read standardized medical histories, then viewed videos of the patients’ faces. Clinicians marked their PTP estimate of CPE and desire for a CTPA before and after seeing the video on a visual analog scale (VAS). RESULTS: Fifty physicians completed all 73 videos. Seeing the patient’s face produced a > 10{\%} absolute change in PTP estimate of CPE in 1,204/3,650 (33{\%}) cases and desire for a CTPA in 1,095/3,650 (30{\%}) cases. The mean area under the receiver operating characteristic curve for CPE estimate was 0.55 ± 0.15, and the change in CPE VAS was negatively correlated with physicians’ standardized test scores (r = −0.23). CONCLUSIONS: Clinicians may use patients’ faces to make clinically important inferences about presence of serious illness and need for diagnostic testing. However, these inferences may fail to align with actual patient outcomes.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.",
author = "Jeffrey Kline and Dawn Neumann and Samih Raad and Schriger, {David L.} and Hall, {Cassandra L.} and Jake Capito and David Kammer",
year = "2017",
month = "4",
day = "11",
doi = "10.1097/ACM.0000000000001674",
language = "English (US)",
journal = "Academic Medicine",
issn = "1040-2446",
publisher = "Lippincott Williams and Wilkins",

}

TY - JOUR

T1 - Impact of Patient Affect on Physician Estimate of Probability of Serious Illness and Test Ordering

AU - Kline, Jeffrey

AU - Neumann, Dawn

AU - Raad, Samih

AU - Schriger, David L.

AU - Hall, Cassandra L.

AU - Capito, Jake

AU - Kammer, David

PY - 2017/4/11

Y1 - 2017/4/11

N2 - PURPOSE: The authors hypothesize patient facial affect may influence clinician pretest probability (PTP) estimate of cardiopulmonary emergency (CPE) and desire to order a computerized tomographic pulmonary angiogram (CTPA). METHOD: This prospective study was conducted at three Indiana University–affiliated hospitals in two parts: collecting videos of patients undergoing CTPA for suspected acute pulmonary embolism watching a humorous video (August 2014–April 2015) and presenting the medical histories and videos to clinicians to determine the impact of patient facial affect on physicians’ PTP estimate of CPE and desire to order a CTPA (June–November 2015). Patient outcomes were adjudicated as CPE+ or CPE− by three independent reviewers. Physicians completed a standardized test of facial affect recognition, read standardized medical histories, then viewed videos of the patients’ faces. Clinicians marked their PTP estimate of CPE and desire for a CTPA before and after seeing the video on a visual analog scale (VAS). RESULTS: Fifty physicians completed all 73 videos. Seeing the patient’s face produced a > 10% absolute change in PTP estimate of CPE in 1,204/3,650 (33%) cases and desire for a CTPA in 1,095/3,650 (30%) cases. The mean area under the receiver operating characteristic curve for CPE estimate was 0.55 ± 0.15, and the change in CPE VAS was negatively correlated with physicians’ standardized test scores (r = −0.23). CONCLUSIONS: Clinicians may use patients’ faces to make clinically important inferences about presence of serious illness and need for diagnostic testing. However, these inferences may fail to align with actual patient outcomes.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

AB - PURPOSE: The authors hypothesize patient facial affect may influence clinician pretest probability (PTP) estimate of cardiopulmonary emergency (CPE) and desire to order a computerized tomographic pulmonary angiogram (CTPA). METHOD: This prospective study was conducted at three Indiana University–affiliated hospitals in two parts: collecting videos of patients undergoing CTPA for suspected acute pulmonary embolism watching a humorous video (August 2014–April 2015) and presenting the medical histories and videos to clinicians to determine the impact of patient facial affect on physicians’ PTP estimate of CPE and desire to order a CTPA (June–November 2015). Patient outcomes were adjudicated as CPE+ or CPE− by three independent reviewers. Physicians completed a standardized test of facial affect recognition, read standardized medical histories, then viewed videos of the patients’ faces. Clinicians marked their PTP estimate of CPE and desire for a CTPA before and after seeing the video on a visual analog scale (VAS). RESULTS: Fifty physicians completed all 73 videos. Seeing the patient’s face produced a > 10% absolute change in PTP estimate of CPE in 1,204/3,650 (33%) cases and desire for a CTPA in 1,095/3,650 (30%) cases. The mean area under the receiver operating characteristic curve for CPE estimate was 0.55 ± 0.15, and the change in CPE VAS was negatively correlated with physicians’ standardized test scores (r = −0.23). CONCLUSIONS: Clinicians may use patients’ faces to make clinically important inferences about presence of serious illness and need for diagnostic testing. However, these inferences may fail to align with actual patient outcomes.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

UR - http://www.scopus.com/inward/record.url?scp=85017474644&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85017474644&partnerID=8YFLogxK

U2 - 10.1097/ACM.0000000000001674

DO - 10.1097/ACM.0000000000001674

M3 - Article

C2 - 28403005

AN - SCOPUS:85017474644

JO - Academic Medicine

JF - Academic Medicine

SN - 1040-2446

ER -