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Variation in clinical practice: forests and trees revisited
Christopher J D Wallis1,2,3, C David Naylor1,4, Allan S Detsky1,4,5
1Institute of Health Policy, Management &Evaluation, University of Toronto, 155 College Street, Toronto, Ontario M5T M36, Canada.
Abstract:
Variations in clinical practice are commonly viewed as a sign of uneven quality of care and attributed to provider self-interest. However, patient preferences, physician practice patterns, and diagnostic and therapeutic uncertainty also cause variations. Greater attention to both doctor-patient interactions and limits to the available evidence might enable more effective assessment and improvement of health-care quality.
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