Vayda E, Mindell W R, Mueller C B, Yaffe B
Can Med Assoc J. 1982 Aug 15;127(4):287-90.
Hypothetical clinical cases were used to investigate surgical decision-making in relation to surgical rates across Ontario. Six procedures were studied (cholecystectomy, colectomy, inguinal herniorrhaphy, hysterectomy, cesarean section and tonsillectomy-adenoidectomy), and substantial differences of opinion regarding the choice of surgical or nonsurgical treatment were recorded. The decision to operate, however, was not made more frequently in Ontario counties with high operative rates, and none of the demographic variables studied were correlated with the decision to operate. Other variables that might have affected operative rates were not taken into account. There were also differences of opinion in referral decisions, but generally internists and pediatricians were less likely to refer the hypothetical cases to surgeons than were family physicians.
采用假设临床病例来研究安大略省各地与手术率相关的手术决策。研究了六种手术（胆囊切除术、结肠切除术、腹股沟疝修补术、子宫切除术、剖宫产术和扁桃体切除术 - 腺样体切除术），并记录了在手术或非手术治疗选择上存在的重大意见分歧。然而，在手术率高的安大略郡县，进行手术的决定并非更频繁做出，且所研究的人口统计学变量均与手术决定无关。未考虑其他可能影响手术率的变量。在转诊决定上也存在意见分歧，但一般来说，与家庭医生相比，内科医生和儿科医生将假设病例转诊给外科医生的可能性较小。
