Wide Variation in Physician Treatments for Disease

Recently, I was discussing with a clinical colleague the variation in treatment for specific disease patterns among physicians. I quoted a classic paper where 137 physicians prescribed 82 separate treatment strategies for female urinary tract infections. Typically, there is no analysis of differences in patient outcomes from such practice variations. Having led studies of this nature in the past, I would assume that 1/3 of the strategies helped, 1/3 made no difference, and 1/3 were worse than no treatment at all. To those that would object to this comment, I would ask where the evidence is to support any other assessment of these results.

Impact on patients for this disease may be small. However, I have pointed out elsewhere that difference in death rates among hearts patients can vary by 50% between cardiologists. Your life may depend on your evaluation of your cardiologist’s evidence based approach to your treatment. Caveat emptor!

Variations among family physicians’ management strategies for lower urinary tract infection in women: a report from the Washington Family Physicians Collaborative Research Network

Berg AO

J Am Board Fam Pract. 1991 Sep-Oct;4(5):327-30

BACKGROUND AND METHODS: This study surveyed a random sample of Washington State family physicians regarding their attitudes toward and usual practices in providing care to women with lower urinary tract infection.

RESULTS: Based on a 70 percent response rate, wide variations in diagnostic testing, treatment, and follow-up strategies were identified. For example, a patient vignette presenting an uncomplicated infection prompted 82 separate management strategies among the 137 replies. Attitude questions also showed wide variations in spite of stated physician confidence and comfort in evaluating and managing urinary tract infection. Associated estimated costs ranged from negligible to more than $250 per case.

CONCLUSIONS: These findings demonstrate significant physician variability in managing women’s lower urinary tract infections.

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