An analysis of drug decisions in a state psychiatric hospital

Sixteen staff physicians at a state psychiatric hospital made decisions that concerned appropriate medication for 40 hypothetical cases. A profile presented for each case described the patient's status on eight symptom dimensions. The physician‐judges examined each profile and specified appropriate drugs and dose levels for the case. Agreement among judges and their prescriptive policies were studied, as well as the manner in which symptoms were weighted in specific drug decisions. While agreement was above chance levels, it was generally very low. Differences in prescriptive choice were traceable to inconsistency in the use of symptom information and individual variations in prescriptive policies because cue (symptom) weighting strategies of judges were dissimilar and sometimes contradictory.