Why do doctors call it “practice variation” instead of poor care?

Did you know that your medical treatment may depend on where you live?  It even has a name: doctors call it “practice variation”. A new U.S. study suggests, for example, that a person living in St. Cloud, Minnesota is twice as likely to undergo invasive back surgery as a patient with a virtually identical diagnosis living in Rochester.  There are a number of reasons for this strange disparity, but one might be that Rochester is the home of the non-profit Mayo Clinic, where surgeons are paid a salary. No matter how many surgeries they do, they earn the same paycheque.  But other physicians elsewhere who are paid per surgery may be inclined to do more surgeries.

Such “practice variation” is not just seen at Mayo. Medicare patients in Fort Myers, Florida, are more than twice as likely to receive hip replacement surgeries compared to their counterparts across the Everglades in Miami, according to Dartmouth Health Atlas researchers.

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When patients demand treatments that won’t work

When my son Ben came down with a  killer sore throat this past summer, he went to his doctor for an antibiotics prescription. He’d suffered this condition in the past, and he knew just what would help ease his painful symptoms. Both he and the doctor agreed this sure sounded like strep, so without even having to wait for the throat swab test results for the group A Streptococcus bacteria that cause strep throat, Ben left the doctor’s office with a prescription for antibiotics in hand.

But were antibiotics the appropriate treatment for Ben’s painful problem?  Continue reading

“You can lead a cardiologist to water but, apparently, you cannot make him drink”

When it comes to interventional cardiology – that’s using balloon angioplasty* and metal stents to open up blocked coronary arteries – it seems that medical evidence is still taking a back seat to doctors’ deeply ingrained practice patterns. Case in point, a warning from the health journalism watchdogs at Health Beat:

“Even though many well-designed clinical studies conclude that drug therapy alone can reduce the risk of heart attack and death in people with stable coronary artery disease just as well as more expensive invasive procedures, many cardiologists continue to use interventions like propping open blocked arteries with costly stents instead of first trying medication.”

Or, as the Los Angeles Times put it in a piece called Cardiologists Rush to Angioplasty Despite Evidence for Value of Drugs:

“You can lead a cardiologist to water but, apparently, you cannot make him drink.”  Continue reading