Surgical decision making and operative rates.

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.