When talking to physicians about practice variation, “Why does hospital A have higher cesarean rates than Hospital B?” is likely to be more effective than “Why does Doctor A have higher cesarean rates than Doctor B?”
The picture that emerges from study of physician economic behavior is mixed, but from the intensity of responses by some professional societies to Medicare's coding modifier proposal, it appears that economic incentives matter a lot to many of their members.
In reports of industry-funded studies that compared the ocular hypotensive efficacy of topical prostaglandins, conclusions in the article abstracts differed from the results of the main outcome measure 62 percent of the time.
The Moseley study found no significant difference between those in the arthroscopic lavage and debridement arm of the study and those in the sham surgery arm.
This process of developing EBM-based guidelines and applying them to clinical care highlights the tension between generating unbiased knowledge based on statistical aggregation and the application of this information to individual patients.
The harms of communicating autism risk can be avoided by helping families to understand risk and to distinguish between poor and good sources of scientific information, which should take families’ interests into account.
AMA J Ethics. 2015;17(4):323-327. doi:
10.1001/journalofethics.2015.17.4.nlit1-1504.