Abstract
BackgroundLittle information is available regarding medical residents' perceptions of patients' health-related quality of life. Patients cared for by residents have been shown to receive differing patterns of care at Veterans Affairs facilities than at community or university settings. We therefore examined: 1) how resident physicians value the health of patients; 2) whether values differ if the patient is described as a veteran; and 3) whether residency-associated variables impact values.MethodsAll medicine residents in a teaching hospital were asked to watch a digital video of an actor depicting a 72-year-old patient with mild-moderate congestive heart failure. Residents were randomized to 2 groups: in one group, the patient was described as a veteran of the Korean War, and in the other, he was referred to only as a male. The respondents assessed the patient's health state using 4 measures: rating scale (RS), time tradeoff (TTO), standard gamble (SG), and willingness to pay (WTP). We also ascertained residents' demographics, risk attitudes, residency program type, post-graduate year level, current rotation, experience in a Veterans Affairs hospital, and how many days it had been since they were last on call. We performed univariate and multivariable analyses using the RS, TTO, SG and WTP as dependent variables.ResultsEighty-one residents (89.0% of eligible) participated, with 36 (44.4%) viewing the video of the veteran and 45 (55.6%) viewing the video of the non-veteran. Their mean (SD) age was 28.7 (3.1) years; 51.3% were female; and 67.5% were white. There were no differences in residents' characteristics or in RS, TTO, SG and WTP scores between the veteran and non-veteran groups. The mean RS score was 0.60 (0.14); the mean TTO score was 0.80 (0.20); the mean SG score was 0.91 (0.10); and the median (25th, 75th percentile) WTP was $10,000 ($7600, $20,000) per year. In multivariable analyses, being a resident in the categorical program was associated with assigning higher RS scores, but no residency-associated variables were associated with the TTO, SG or WTP scores.ConclusionPhysicians in training appear not to be biased either in favor of or against military veterans when judging the value of a patient's health.
Highlights
Little information is available regarding medical residents' perceptions of patients' health-related quality of life
The purpose of our study was: 1) to determine how resident physicians value the health of patients, 2) to examine whether residents' values differ based upon whether the patient is described as a veteran versus a non-veteran, and 3) to examine whether residency-associated variables or demographics impact the values ascribed to health states
Multivariable determinants of health values for congestive heart failure In multivariable analyses, we examined whether the patient's veteran status and the respondents' age, sex, race, program type, level of training, current rotation type, proximity of their last call date, and risk attitudes were related to rating scale (RS), time tradeoff (TTO), standard gamble (SG) and willingness to pay (WTP) scores
Summary
Little information is available regarding medical residents' perceptions of patients' health-related quality of life. Nonminority medical trainees have been shown to assign higher health values to health states of (hypothetical) non-minority patients, and health professionals and other groups have been shown to assign higher health values to female patients than male patients [8,9] Such differences in perceptions surrounding HRQOL have the potential to influence medical decision-making. Attending and resident physicians' assessments of the HRQOL of hypothetical patients (with a respiratory disorder or severe stroke) were shown to be lower than patients' HRQOL assessments of the same hypothetical health states Those differences were associated with resuscitation preferences in the expected direction, with physicians being less likely to favor resuscitation for such a patient [6]
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