THE PERIODIC HEALTH EXAMINATION PROVIDED TO ASYMPTOMATIC OLDER WOMEN - AN ASSESSMENT USING STANDARDIZED PATIENTS

Objectives: To describe physical examination and cancer prevention ser vices provided by primary care physicians in response to the request f or a ''checkup'' by an asymptomatic 55-year-old woman seeking to estab lish ongoing care; to assess the effects of two interventions (educati on and office organization) intended to improve these services; and to assess the feasibility of using ''standardized'' patients to evaluate physician responses to such a request. Setting: Northern New England. Participants: Fifty-nine primary care physicians who were accepting n ew patients and were participating in a study of early detection and p revention of cancer. Design: Cross sectional; observations of patient visits. Interventions: Actresses trained to portray a specific patient role (''standardized'' or ''simulated'' patients) visited each physic ian once. Physicians were blinded to the simulated patients' true iden tities. Measurements: Actresses reported the components of the general physical examination and the cancer-related'' checkup.'' Most interac tions were audiotaped. Results: Fourteen physical examination componen ts were measured, ranging from assessment of vibratory sense (5%) to m easurement of blood pressure (98%). Provision of 10 services recommend ed by the National Cancer Institute to standardized patients included 16% being advised to reduce dietary fat; 53% to do monthly breast self -examination; 74% to quit smoking; and 89% to obtain a mammogram. Phys icians spent from 5 to 60 minutes with the patients. Two physicians di d not charge, whereas others charged from $24 to $108. Study group ass ignment was not associated with statistical differences in provider pe rformance. Two standardized patients (3%) were detected by physicians. Audiotapes were used to verify the actresses' ability to replicate th eir scenario (consistently repeat their performance) and to verify phy sician performance. Conclusions: Physician responses to an identical p atient request varied widely in terms of time spent with the patient, the services provided, and the cost of the visit. Using standardized p atients is a feasible method for assessing physician performance of th e periodic health examination while controlling for case mix.