Surgical decision making and operative rates
I. M. Rutkow and B. H. Starfield
A total of 4,687 surgeons from Canada, England, and the United States were
asked to assess the need for surgical intervention in fictional case
vignettes. The case histories omitted external influences, eg, all aspects
of the physician-patient relationship and any socioeconomic,
organizational, or demographic influences. Correlations were made between
known operative rates in the three countries and the surgeon's responses to
the case histories. Evidence was found to indicate there are differences in
the way surgeons from the three countries treat their patients when their
clinical decisions are not affected by socioeconomic, organizational, and
demographic influences. However, no evidence was noted that suggested such
"simple" technical decisions regarding need for surgery have a major impact
in determining a country's known surgical rates. The more important factors
that ultimately determine known rates of surgery seem to be derived from
broad economic and social forces in any given society.
