A controlled study of variation among family physicians in HIV screening recommendations

The results of a study of screening recommendations for human immunodeficiency virus (HIV) by family physicians are reported. Of 209 family practice residents and clinical faculty from the four UCLA-affiliated family practice residency programs surveyed, 110 (53%) responded. Each physician was presented with an identical set of five clinical scenarios and asked to make an HIV screening decision in each case. The physicians were also asked to choose from a list of 11 physician roles the one role that best described why they chose to recommend or not recommend an HIV screening test in each particular scenario. Marked variation was observed among the physicians' HIV screening recommendations. The degree of variation was similar between residents and clinical faculty. The physicians predominantly cited concern for the patient's well-being over concern for the public's well-being in making their HIV screening decisions. Three physician roles, (1) to protect the patient from mental suffering, (2) to protect the unborn from disease, and (3) to optimize the patient's future health care, were the roles most cited when an HIV screening test was recommended. Two physician roles, (1) to protect the patient from mental suffering, and (2) to allocate limited health resources properly, were the roles most cited when an HIV screening test was not recommended.