Discrepancy between medical decisions for individual patients and for groups

Article Abstract:

Physicians are people, and like all others have inconsistencies and discrepancies of behavior. People tend to view isolated risks differently than repeated risks, and people tend to view statistical lives differently than the lives of identified individuals. Likewise, a physician may spend more time, effort, and thought on the treatment of an isolated case than if the same symptoms are encountered repeatedly. In an experimental survey involving hypothetical cases, physicians were more likely to consider unusual diagnoses for individual patients than for groups of patients with the same symptoms. Physicians were also more likely to suggest an office visit for patients with unique symptoms than for several patients with the same symptoms. These differences were seen among house staff, HMO physicians, academic physicians, and doctors at the county hospital. Conversely, difficult subjects like requesting organ donations were more likely to be discussed when the physicians were dealing with several similar patients than with one. These differences in perspective between dealing with individual patients and dealing with sets of patients are not intrinsically good or bad. They should, however, be considered as possible influences when examining the processes by which health care decisions are being made. (Consumer Summary produced by Reliance Medical Information, Inc.)

Medicine, Practice, Medical practice, Health services administration

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Hospital expenditures in the United States and Canada

Article Abstract:

Canadian hospitals spend less on health care than American hospitals even though more Canadians are admitted to a hospital than Americans and they remain hospitalized longer. Information on hospital admissions and their associated costs in 1987 were analyzed. Data were collected comparing the US with Canada, California with Ontario and two California hospitals with two Ontario hospitals. Costs per patient admitted were 39% higher in the US than in Canada, and 63% higher in California than in Ontario. However, US hospitals had fewer hospital beds, fewer admissions and shorter hospitalizations. The increased costs may result from the fact that US hospitals use more expensive resources. US hospitals also spend an enormous amount on administrative functions such as insurance billing.

Economic aspects, Hospitals

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The treatment of unrelated disorders in patients with chronic medical diseases

Article Abstract:

Physicians in Canada may be undertreating other, unrelated conditions in patients with chronic diseases. Researchers evaluated the care of 1,344,145 elderly patients eligible for free medications under the Ontario Drug Benefit program. Patients with diabetes were 60% less likely to receive estrogen-replacement therapy, when medically indicated. Those with emphysema were 31% less likely to be taking cholesterol-lowering medications. Doctors may be neglecting other medical conditions for which treatment could be beneficial, while focusing on management of the primary, chronic disease.

Health aspects, Care and treatment, Aged, Elderly, Research, Comorbidity

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