Ebola: Survey Says Physicians Are Too Confident in Their Ability to Assess Patients

Ebola can persist in wastewater, plastic, and steel and the virus has even gone undetected in a blood test. But how many physicians are actually prepared to properly assess a patient with a potential case of the deadly disease? A team from the Massachusetts General Hospital (MGH) found that physicians least likely to encounter patients with Ebola were more likely to use excessive approaches.

Ebola can persist in wastewater, plastic, and steel and the virus has even gone undetected in a blood test. But how many physicians are actually prepared to properly assess a patient with a potential case of the deadly disease? A team from the Massachusetts General Hospital (MGH) found that physicians least likely to encounter patients with Ebola were more likely to use excessive approaches.

A survey consisting of 23 questions was emailed to physicians between December 2014 and January 2015. Of the 202 primary care doctors who responded, 95% said they felt very prepared or somewhat prepared to diagnose a potential case of Ebola and 97% felt the same about informing patients about Ebola risk. Encouraging results? Yes. Accurate results? Not necessarily. Only about 50 to 70% participants gave answers to hypothetical situations that fit guidelines provided by the Centers for Disease Control and Prevention (CDC).

“Our findings demonstrate significant variation in how doctors make decisions in situations of uncertainty and show how decision-making can be shaped by geography, sources of information and other factors,” corresponding author Ishani Ganguli, MD, of the MGH Department of Medicine, said in a news release.

One hypothetical scenario on the survey, for example, asked their thoughts on a patient with flu-like symptoms who had recently traveled to South Africa. Twenty-four percent responded that Ebola was the more likely cause, regardless of the fact that there have not been any cases of Ebola in that country. Other questions presented situations where the patients had little or no risk of contracting the illness; and yet answers indicated that some physicians would have taken excessive measures and would not have been able to properly assess their own risk of exposure.

According to the report published in the Journal of Internal Medicine, questions that related to Ebola transmission and incubation revealed that 20% would have gone with overly intense approaches. In addition, 75% of calls made to the CDC were about patients who had no risk of becoming infected with Ebola. The abundance of physician overreaction could be due in part to the heavy media coverage on the disease, the authors hypothesized. Geographic location could also have something to do with it since most physicians have not had direct experience with Ebola — noting that only four cases were confirmed in the US during the most recent outbreak.

“It could be that those not working in areas where they might encounter Ebola received less information from their institutions or local government sources, making them more fearful of the disease and more aggressive in evaluating potential cases,” Ganguli explained.

Additional findings determined that 88% of the participants viewed CDC guidelines regarding Ebola at least once during the past year. The CDC guidelines were the most common source of information for the clinicians, however, the team suggests having more resources available.

“It would be interesting to investigate the reasons why some doctors would decide to test low-risk patients for Ebola or send them to the hospital and to determine the real impact of misplaced concern about Ebola in terms of both resource allocation and delayed diagnosis of a patient’s real illness,” Ganguli concluded.