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Diagnostic Certainty as a Source of Medical Practice Variation in Coronary Heart Disease: Results from a Cross-National Experiment of Clinical Decision Making

Author

Listed:
  • Karen E. Lutfey

    (New England Research Institutes, Watertown, Massachusetts, klutfey@neriscience.com)

  • Carol L. Link

    (New England Research Institutes, Watertown, Massachusetts)

  • Lisa D. Marceau

    (New England Research Institutes, Watertown, Massachusetts)

  • Richard W. Grant

    (Massachusetts General Hospital and Harvard Medical School, Boston)

  • Ann Adams

    (University of Warwick, Coventry, UK)

  • Sara Arber

    (University of Surrey, Guildford, UK)

  • Johannes Siegrist

    (Dusseldorf University, Dusseldorf, Germany (JS); and University of Hamburg, Hamburg, Germany)

  • Markus Bönte

    (New England Research Institutes, Watertown, Massachusetts)

  • Olaf von dem Knesebeck

    (New England Research Institutes, Watertown, Massachusetts)

  • John B. McKinlay

    (New England Research Institutes, Watertown, Massachusetts)

Abstract

The authors examined physician diagnostic certainty as one reason for cross-national medical practice variation. Data are from a factorial experiment conducted in the United States, the United Kingdom, and Germany, estimating 384 generalist physicians’ diagnostic and treatment decisions for videotaped vignettes of actor patients depicting a presentation consistent with coronary heart disease (CHD). Despite identical vignette presentations, the authors observed significant differences across health care systems, with US physicians being the most certain and German physicians the least certain (P

Suggested Citation

  • Karen E. Lutfey & Carol L. Link & Lisa D. Marceau & Richard W. Grant & Ann Adams & Sara Arber & Johannes Siegrist & Markus Bönte & Olaf von dem Knesebeck & John B. McKinlay, 2009. "Diagnostic Certainty as a Source of Medical Practice Variation in Coronary Heart Disease: Results from a Cross-National Experiment of Clinical Decision Making," Medical Decision Making, , vol. 29(5), pages 606-618, September.
    • Handle: RePEc:sae:medema:v:29:y:2009:i:5:p:606-618
    DOI: 10.1177/0272989X09331811
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    References listed on IDEAS

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    1. Armstrong, Donna L. & Strogatz, David & Wang, Ruby, 2004. "United States coronary mortality trends and community services associated with occupational structure, among blacks and whites, 1984-1998," Social Science & Medicine, Elsevier, vol. 58(11), pages 2349-2361, June.
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    Cited by:

    1. Daniel Hausmann & Vera Kiesel & Lukas Zimmerli & Narcisa Schlatter & Amandine von Gunten & Nadine Wattinger & Thomas Rosemann, 2019. "Sensitivity for multimorbidity: The role of diagnostic uncertainty of physicians when evaluating multimorbid video case-based vignettes," PLOS ONE, Public Library of Science, vol. 14(4), pages 1-16, April.

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