MEDICAL DECISION-MAKING AND PERCEIVED SOCIOECONOMIC-CLASS

Objective: To examine the effects that a physician's knowledge of a pa tient's socioeconomic status or profession has on clinical decision ma king in an outpatient setting. Methods: We mailed a survey to all 336 members of the Academy of Medicine of Cleveland who are general intern ists, family practitioners, or general practitioners. Physicians were randomized before the initial mailing to receive one of the two questi onnaires. Physicians in group A were given two simulated clinical scen arios in which the socioeconomic status or profession of the patient w as identified, followed by management options. Physicians in group B w ere given the same scenarios without any suggestion of the patient's p rofession or social standing. Outcomes that reflect decision making, i ntensiveness of evaluation, and treatment course were compared for the two groups. Data were analyzed using t tests and chi(2) After Bonferr oni correction, a P less than or equal to.01 was considered significan t. Results: The response rate was 60%. For clinical scenario 1, no dif ference was noted in the number of tests ordered. However, physicians in group A responding to clinical scenario 2 ordered more total tests than did physicians in group B (P=.03), including complete blood cell counts (45% vs 29%, P=.01). In both scenarios, earlier follow-up visit s were scheduled by physicians in group A compared with those in group B (P=.01). Conclusion: Our results do not support findings by other i nvestigators that more tests are ordered when physicians perceive thei r patients to be of higher socioeconomic status. Intensity of follow-u p, however, was greater when physicians believed the patient was in a more prominent profession or was of higher socioeconomic status.