Acute otitis media in children: diagnostic and therapeutic dilemmas.

Otitis media is still a condition with a level of diagnostic confidence lower than physicians fresh from hospital training are accustomed to. Even with improved diagnostic criteria, there will still be other influences which will affect the physician's prescribing habits, especially in the treatment of early signs of otitis media. This study shows that the determinants of prescribing behavior by ambulatory care physicians are more complex than traditional teaching of students implies. The appropriate use of antibiotics is discussed, and the importance of limiting additional medication is stressed. It is the author's contention that the outcome of care is frequently being measured without attempting to examine closely the dilemmas facing ambulatory care physicians in their day-to-day decisions. Otitis media has been used as the model in this report, but the complexities of clinical judgment are equally applicable to other common infections presenting to the primary care physician.