Publications by authors named "Mitchell A Medow"
Objective: To better understand 1) why patients have a negative perception of the use of computerized clinical decision support systems (CDSSs) and 2) what contributes to the documented heterogeneity in the evaluations of physicians who use a CDSS.
Methods: Three vignette-based studies examined whether negative perceptions stemmed directly from the use of a computerized decision aid or the need to seek external advice more broadly (experiment 1) and investigated the contributing role of 2 individual difference measures, attitudes toward statistics (ATS; experiment 2) and the Multidimensional Health Locus of Control Scale (MHLC; experiment 3), to these findings.
Results: A physician described as making an unaided diagnosis was rated significantly more positively on a number of attributes than a physician using a computerized decision aid but not a physician who sought the advice of an expert colleague (experiment 1).
While decisions made according to Bayes' theorem are the academic normative standard, the theorem is rarely used explicitly in clinical practice. Yet the principles can be followed without intimidating mathematics. To do so, one can first categorise the prior-probability of the disease being tested for as very unlikely (less likely than 10%), unlikely (10-33%), uncertain (34-66%), likely (67-90%) or very likely (more likely than 90%).
View Article and Find Full Text PDFBackground: Physicians are reluctant to use decision aids despite their ability to improve care. A potential reason may be that physicians do not believe decision aid advice.
Objective: To determine whether internal medicine residents lend more credence to contradictory decision aid or human advice.
Sparklines, embedded contextual information graphics, can help reduce diagnostic errors by highlighting trends in data, simplifying cognitive tasks and providing context for decision making. Examples applied to heparin induced thrombocytopenia, cardiac catheterization and pediatric viral illness illustrate the concept. Sparklines are ideal in situations where the limited textual data representations obfuscate interpretation, the graphic aids interpretation of the data, or the graphic guides decision making.
View Article and Find Full Text PDFSevere constipation associated with extended-release bupropion therapy.
Am J Health Syst Pharm
August 2008
Purpose: A case of bupropion-induced constipation is reported.
Summary: A 38-year-old man went to a clinic with a chief complaint of depression. He was prescribed extended-release bupropion 150 mg orally daily.
Background: Mock jurors were more likely to side with the physician-defendant if he recommended an operation when there were many symptoms and refrained when there were few symptoms compared with a physician who did the converse. The use of a decision aid had no influence on this binary standard-of-care decision. Among those physicians deemed liable by the jurors, defying the aid resulted in heightened punishment compared with heeding it.
View Article and Find Full Text PDFObjective: To ascertain whether a physician who uses a computer-assisted diagnostic support system (DSS) would be rated less capable than a physician who does not.
Method: Students assumed the role of a patient with a possible ankle fracture (experiment 1) or a possible deep vein thrombosis (experiment 2). They read a scenario that described an interaction with a physician who used no DSS, one who used an unspecified DSS, or one who used a DSS developed at a prestigious medical center.
Purpose: In order to better understand physicians' perspectives about the use of clinical information technology (CIT) to reduce medical errors, we asked physicians about opportunities and issues around clinical use of computerized physician order entry (CPOE) systems, order sets within CPOE, and handheld computers (HHCs).
Methods: We conducted 10 focus groups including 71 physicians involved in technology implementation efforts across the US between April 2002 and February 2005.
Results: Two major themes emerged across focus groups around reliance on CIT to reduce errors: (1) can it work? and (2) at what cost to the medical profession? Within the first theme, physicians expressed concern about the appropriateness of physician-directed CIT as a solution for medical errors, concerns regarding the current technical capabilities and level of technical support for CIT solutions, and concern about the introduction of new errors.
Objective: To describe strategies that organizations select to support physicians' use of handheld computers (HHCs) in clinical practice and to explore issues about facilitating HHC use.
Design: A multidisciplinary team used focus groups and interviews with clinical, administrative, and information technology (IT) staff to gather data from 161 informants at seven sites. Transcripts were coded using a combination of deductive and inductive approaches to both answer research questions and identify patterns and themes that emerged in the data.
Objective: To examine doctors' perspectives about their experiences with handheld computers in clinical practice.
Design: Qualitative study of eight focus groups consisting of doctors with diverse training and practice patterns.
Setting: Six practice settings across the United States and two additional focus group sessions held at a national meeting of general internists.
Simple predictors of survival in head and neck squamous cell carcinoma.
Arch Otolaryngol Head Neck Surg
November 2002
Objective: To develop a simple prognostic survival rule from easily obtained characteristics of patients undergoing potentially curative resection of head and neck squamous cell carcinoma using classification and regression trees.
Design: Inception cohort.
Setting: Tertiary care center.