DO GENERAL-PRACTITIONERS ACT CONSISTENTLY IN REAL PRACTICE WHEN THEY MEET THE SAME PATIENT TWICE - EXAMINATION OF INTRADOCTOR VARIATION USING STANDARDIZED (SIMULATED) PATIENTS

Objective: To assess the variation within individual general practitio ners facing the same problem twice in actual practice under unbiased c onditions. Design: General practitioners were consulted during normal surgery hours by a standardised patient portraying a patient with angi na pectoris. Six weeks later the same general practitioners were consu lted again by a similar standardised patient portraying a similar case . The patients reported on the consultations. Setting: Trondheim, Norw ay. Subjects: Of 87 general practitioners invited by letter, 28 (32%) agreed to participate without hesitation; nine others (10%) wanted mor e information before consenting. From these 24 were selected and visit ed. Main outcome measures: Number of actions undertaken from a guideli ne in both rounds of consultations. Duration of consultations. Results : The mean (range, interquartile range) guideline score, total score, and duration of consultation were not significantly different between the first and second patient encounters for the group as a whole. For individual doctors the mean (SD) difference was -0.09 (3.36) for the g uideline score, 0.30 (8.1) for the total score, and -0.87 (9.01) for c onsultation time. Conclusions: The study shows that assessment of perf ormance in real practice for a group of general practitioners is consi stent from the first round of consultations to the second round. Howev er, significant variation occurs in performance of individual physicia ns.