Over-diagnosis of childhood asthma by medical residents: who is to blame?

Abstract

Asthma is a common chronic childhood illness and results in considerable morbidity for sufferers. It also imposes serious socio-economic burden on families and the healthcare system. This leads to a depletion of scarce resources. To minimize these effects, proper diagnosis of asthma is important. Objective: To evaluate the ability of medical residents (doctors in training) to effectively and accurately diagnose asthma. Method: A semi-structured self-administered questionnaire on asthma management was filled out by medical residents from the six geo-political zones participating in an update course in Nigeria in August 2009. Results: Of sixty-four residents who completed the questionnaire, 28 (43.8%) were males and 36 (56.2%), females. Post graduation years (mean ± SD) and range were 6.47 ± 2.2 and 2 – 12 years respectively. The burden of asthma as seen in practice areas was occasionally (35, 54.7%), frequently (28, 43.8%) and rarely, (1, 1.5%). No medical resident reported “Not at all”. Of the 64 residents, (10, 15.6%) practiced appropriate method for asthma diagnosis, while (54, 84.4%) practiced inappropriate method for diagnosis. Nine (14.1%) residents reported availability and use of spirometer in their practice centre. Years post graduation and gender did not correlate significantly with appropriateness of asthma diagnosis; p = 0.616, p = 0.505 respectively. Conclusion: Study supports over-diagnosis of asthma by medical residents and consequently mis-management. Capacity building in area of asthma management will be enhanced by emphasis on asthma management in undergraduate curriculum, residency training and continuous medical education on the proper management of asthma.