Rovner D R, Rothert M L, Holmes M M, Ravitch M M, Holzman G B, Elstein A S
Med Decis Making. 1985 Fall;5(3):279-92. doi: 10.1177/0272989X8500500304.
Health care costs are an increasing burden upon American society. Referral of patients to a specialist generates additional cost. We studied the reasons behind decisions to refer patients with uncomplicated obesity to endocrinologists. Obesity may be viewed as a paradigm of diseases with relatively well-known etiology, low morbidity and mortality, chronicity, and poor outcome from standard therapy. In addition, it is a disease that is rarely curable by medical intervention, requiring behavioral change. Physicians have little direct experience in the differential diagnosis of endocrine disease, because of its low prevalence. We studied the referral decisions of 45 physicians in three medical specialties. Clinical decision making was studied using a standard set of 24 carefully structured case reports of obese women, all without obvious endocrine disease cues on history or physical. In these cases the patients' desire to be seen by endocrinologists was the major factor in the decision to refer. Referrals were not made primarily to rule out suspected endocrine disorder or because of concern for increased risk of morbidity.
医疗保健费用给美国社会带来的负担日益加重。将患者转诊给专科医生会产生额外费用。我们研究了将单纯性肥胖患者转诊给内分泌科医生这一决策背后的原因。肥胖可被视为一种病因相对明确、发病率和死亡率较低、具有慢性特征且标准治疗效果不佳的疾病范例。此外，这是一种很少能通过医学干预治愈、需要行为改变的疾病。由于内分泌疾病的患病率较低，医生在其鉴别诊断方面几乎没有直接经验。我们研究了三个医学专科的45名医生的转诊决策。使用一组精心构建的24份肥胖女性病例报告来研究临床决策，所有病例在病史或体格检查中均无明显内分泌疾病线索。在这些病例中，患者希望由内分泌科医生诊治是转诊决策的主要因素。转诊并非主要为了排除疑似内分泌紊乱，也不是因为担心发病率增加。
