An editorial published in this week's JAMA highlights the importance of physicians using all available clinical assessment tools when considering how to treat patients. Written by Robert Vinci, MD, chief of pediatrics at Boston Medical Center and chair of pediatrics at Boston University School of Medicine and Howard Bauchner, MD, editor-in-chief of JAMA, the editorial examines results of a study published in the same issue of the journal as an example of how doctors can often over-emphasize certain types of data.
The study examined how pediatric emergency medicine physicians treat a respiratory tract infection called bronchiolitis in infants, and how they incorporate factors such as respiratory exam, imaging tools and blood tests when deciding on treatment. Doctors also commonly use the level of oxygen saturation, measured by a simple machine called an oximeter, which measures how well the blood carries oxygen; generally, the higher the number, the better. In the study, emergency department physicians were presented with two groups of infants with bronchiolitis, one in which they were shown the true oxygen saturation level and the other in which they were shown an altered number that was three percent higher than the actual saturation level.
The results indicated that the clinicians were 40 percent less likely to admit the patients with the falsely higher oxygen saturation level into the hospital even though the two groups had otherwise similar symptoms and illness severity. This supports the notion that clinicians may often overlook other important components of the clinical assessment in favor of a single parameter.
The editorial stresses the challenges that clinicians often face in treating disorders where there are no standard treatment protocols and emphasizes that analyzing all available data to make the best clinical judgments and decisions is the true art of medicine.
"Although it may seem wrong, the study authors followed established guidelines such as obtaining consent from parents and also ensured the safety of patients by only enrolling patients with mild disease," said Vinci about the ethics of deceiving physicians for the purpose of research in the editorial. "In an area of research where there is much uncertainty about how we should best treat patients, studies such as this may be necessary to gather important information, as long as researchers ensure patient safety."
- Robert Vinci, Howard Bauchner. Bronchiolitis, Deception in Research, and Clinical Decision Making. JAMA, 2014; 312 (7): 699 DOI: 10.1001/jama.2014.8638
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