Hypothetical clinical cases were used to investigate surgical decision-making in relation to surgical rates across Ontario. Six procedures were studied (cholecystectomy, colectomy, inguinal herniorrhaphy, hysterectomy, cesarean section and tonsillectomy-adenoidectomy), and substantial differences of opinion regarding the choice of surgical or nonsurgical treatment were recorded. The decision to operate, however, was not made more frequently in Ontario counties with high operative rates, and none of the demographic variables studied were correlated with the decision to operate. Other variables that might have affected operative rates were not taken into account. There were also differences of opinion in referral decisions, but generally internists and pediatricians were less likely to refer the hypothetical cases to surgeons than were family physicians.
Notes
Cites: N Engl J Med. 1969 Oct 16;281(16):880-45812257
Cites: N Engl J Med. 1970 Jan 15;282(3):135-445409538
Cites: N Engl J Med. 1973 Dec 6;289(23):1224-94748597
Cites: Science. 1973 Dec 14;182(4117):1102-84750608
Cites: Can Med Assoc J. 1974 Feb 2;110(3):301 passim4204596
Cites: Can J Surg. 1976 May;19(3):235-421277019
Cites: N Engl J Med. 1977 Jun 9;296(23):1326-8870826
Cites: Can Med Assoc J. 1977 Jun 4;116(11):1263-6861883
Cites: N Engl J Med. 1977 Sep 29;297(13):699-705895790
Cites: Med Care. 1978 Dec;16(12):984-94713632
Cites: Med Care. 1979 Apr;17(4):390-6431149
Cites: Ann Surg. 1979 Sep;190(3):409-19485616
Cites: Can J Surg. 1981 Jan;24(1):19-217459731
Cites: Am J Public Health. 1981 Jun;71(6):591-6007235097