PUBHLTH 1 Lecture Notes - Lecture 7: Coronary Artery Bypass Surgery, Benign Prostatic Hyperplasia, Watchful Waiting
Document Summary
Small area analysis - large variations in practice style by geographical. More variation for conditions on which evidence for appropriate therapy exists. Sometimes more than one therapy may be appropriate. Doctors may adjust behavior when informed of other doctors practice patterns. Field of dreams effect - availability of services leads to more use of these services: more back surgeons, more back surgeries and more hospital beds equals more hospitalizations and more patients die in hospital. Evidence in some cases that financial considerations may affect medical decisions. Watchful waiting vs prostatectomy (benefits are overstated and complications are understated). Patients need to be informed so they can choose. Medical errors - medication errors, wrong side surgeries. Contribution of medical care to health - medical care is rationed by ability to pay. Racial inequities in care, even when ability to pay is same. Blacks and hispanics receive poorer treatment for many conditions (less likely for coronary bypass surgery to be recommended).
