Rutkow I M, Starfield B H
Arch Surg. 1984 Aug;119(8):899-905. doi: 10.1001/archsurg.1984.01390200019005.
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.
来自加拿大、英国和美国的共计4687名外科医生被要求评估虚构病例小插曲中手术干预的必要性。病例史省略了外部影响，例如医患关系的所有方面以及任何社会经济、组织或人口统计学影响。对这三个国家已知的手术率与外科医生对病例史的反应进行了相关性分析。有证据表明，当临床决策不受社会经济、组织和人口统计学影响时，这三个国家的外科医生对待患者的方式存在差异。然而，没有证据表明关于手术必要性的这种“简单”技术决策对确定一个国家已知的手术率有重大影响。最终决定已知手术率的更重要因素似乎来自任何特定社会中的广泛经济和社会力量。
