Kiderman, A., et al, Arch Intern Med 169(5):524, March 9, 2009

METHODS: These Israeli authors evaluated the influence of bias introduced in a patient history on physicians’ perceptions regarding clinical findings and actual management. Healthy actors visited 32 clinicians (30 trained outside the U.S.), reporting a history consistent with viral infection (headache, fever, cough and runny nose for two days with throat discomfort and hoarseness on the day of the visit) or bacterial infection (sore throat for one day with headache and fever with malodor of the mouth but without cough or nasal discharge). None of the actors had physical findings consistent with illness, as confirmed on pre-visit evaluations and photography.

RESULTS: The experience level of the participating physicians ranged from 5 to 32 years (mean, 19 years), and 13 of the physicians were board-certified in family medicine. The physicians recorded slight, moderate or severe pharyngeal erythema for 41%, 34% and 6% of the actors presenting the viral script, and for 22%, 31% and 22%, respectively, of those presenting the bacterial script. An exudate was recorded for 6% and 25% of the actors presenting the viral and bacterial scripts, respectively, and lymphadenopathy was recorded for 16% and 26%, respectively. Throat culture was done for 47% of the actors presenting the script consistent with viral illness, and for 73% of those presenting the bacterial illness script, and antibiotics were prescribed for 21% and 79%, respectively.

CONCLUSIONS: These findings demonstrate that physicians often “find” physical findings consistent with what they expect to find, based on a patient’s history, and that this appears to be true regardless of the level of physician experience.