Antibiotics for otitis media: can we help doctors agree?

Wide variations in antibiotic prescribing for otitis media have suggested the need to discover the causes of the differences and help doctors reach agreement. Simulated cases--in the form of written clinical data extracts based on real patients--were used to study the diagnostic and prescribing behaviour of a group of six general practitioners. Clinical judgement analysis was used to model the way in which doctors diagnosed otitis media and their policy for using antibiotics. Most doctors performed consistently and their judgements could be fitted well to models using a small number of symptoms and signs. These models often differed from the policy they believed they were operating. This information was used as process feedback in a group discussion to help improve agreement within the practice on the management of otitis media. Some of the variation in behaviour observed at the start of the study was reduced by significant changes in that of the trainee. Other doctors changed little and some were sceptical of the validity of the experimental methods. The prospects for and difficulties of this type of analysis are discussed.