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Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care
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The Hidden Influences: Psychological Drivers of Medical Practice Variation.

Sagi Shashar1,2, Moriah E Ellen2,3, Ehud Davidson4

  • 1Clinical Research Center, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel.

Journal of Clinical Medicine
|October 29, 2025
PubMed
Summary

Physician behavioral traits explain a small fraction of medical practice variation (MPV). Most MPV remains unexplained, suggesting other factors influence how doctors practice medicine.

Keywords:
MPV determinantsMPV explanationhealth servicesmedical practice variationprimary care

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Area of Science:

  • Healthcare Delivery
  • Medical Practice Variation
  • Physician Behavior

Background:

  • Previous research indicates patient, physician, and practice characteristics do not fully explain variations in medical practice patterns.
  • This study investigates the role of physicians' personal behavioral characteristics in understanding medical practice variation (MPV).

Purpose of the Study:

  • To assess the extent to which physicians' personal behavioral traits explain MPV.
  • To compare the explanatory power of behavioral traits against patient, physician demographic, occupational, and practice characteristics.

Main Methods:

  • Cross-sectional study involving primary care physicians from Clalit Health Services in southern Israel.
  • Validated surveys assessed physician traits: risk-taking, tolerance for ambiguity, stress due to uncertainty, fear of malpractice, and empathy.
  • Generalized linear mixed models and Nakagawa's R² were used for analysis.

Main Results:

  • A total of 146 physicians participated (91.3% response rate).
  • Patient characteristics explained 18.9% of MPV, practice characteristics 10.2%, and physician demographics 8.3%.
  • Physician behavioral traits explained only 2.3% of MPV, with overall MPV explained being 40.4%.

Conclusions:

  • Personal behavioral characteristics account for a minor portion of MPV.
  • A significant majority (60%) of MPV remains unexplained by the factors studied.
  • This suggests potential limitations in current assessment methods or that behavioral traits are not primary drivers of MPV.