Bringing the patient back in: Guidelines, practice variations, and the social context of medical practice

We challenge assumptions that have guided much research and policy aimed at understanding and reducing medical practice variation. Paramount is the focus on doctors as the cause of variation to the neglect of other possible influences. Some research literature suggests that patients, families, and t...

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Bibliographic Details
Published in:International journal of technology assessment in health care 2002-12, Vol.18 (4), p.747-761
Main Authors: GREER, Ann Lennarson, GOODWIN, James S, FREEMAN, Jean L, WU, Z. Helen
Format: Article
Language:English
Subjects:
Attitude to Health - ethnology
Biological and medical sciences
Breast cancer
Breast Neoplasms - ethnology
Breast Neoplasms - surgery
Cancer therapies
Consensus Development Conferences, NIH as Topic
Decision making
Diffusion of Innovation
Education
Family Practice - organization & administration
Female
Gynecology. Andrology. Obstetrics
Health care
Health participants
Humans
Hypotheses
Mammary gland diseases
Mastectomy, Segmental
Medical practices
Medical research
Medical sciences
Patient Participation
Patients
Physician-Patient Relations
Physicians
Practice Guidelines as Topic
Practice Patterns, Physicians
Preferences
Public health. Hygiene
Public health. Hygiene-occupational medicine
Surgeons
Surgery
Tumors
United States
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Summary:We challenge assumptions that have guided much research and policy aimed at understanding and reducing medical practice variation. Paramount is the focus on doctors as the cause of variation to the neglect of other possible influences. Some research literature suggests that patients, families, and the community context of practice may also influence treatment decisions. Failure to question present assumptions, despite weak evidence in support of them, may account for inability to explain persistent practice variation, develop appropriate implementable guidelines, or anticipate the effect on treatment decisions of greater patient involvement. In this paper, we discuss the weak response to the NIH Consensus Conference on early stage breast cancer because it may have reflected these problems. We urge a more complex and more empirical approach in explaining treatment choice and guidelines sensitive to the potential for value differences.
ISSN:0266-4623
1471-6348
DOI:10.1017/S0266462302000569