Dear Martin,
I think you should be cautious in assuming that responses to
vignettes are the same as responses to real patients. For an
example, see:
Morrell DC. Roland MO. Analysis of referral behaviour: responses
to simulated case histories may not reflect real clinical behaviour.
British Journal of General Practice. 40(334):182-5, 1990 May.
Abstract
In an attempt to develop a measure of the referral behaviour of
general practitioners, 21 simulated case histories were constructed
which presented between three and six stages at which a decision
was required whether or not refer a 'patient' to hospital. Twenty
general practitioners completed the case histories and their
responses were compared with their referral rates to outpatient
departments. No significant correlations were found between the
doctors' responses to the vignettes and their actual referral rates,
and the repeatability of the vignettes was disappointing. The fact
that the case histories appeared realistic to the doctors who
completed them was not reflected in objective measures of their
validity. Simulated case histories should not be used as a method
of measuring doctors' behaviour without establishing their validity
and reliability.
Bruce
Bruce Guthrie,
MRC Training Fellow in Health Services Research,
Department of General Practice,
University of Edinburgh,
20 West Richmond Street,
Edinburgh EH8 9DX
Tel 0131 650 9237
e-mail [log in to unmask]
|