Skip to main content
PMC home page
The British Journal of General Practice logoLink to The British Journal of General Practice
. 1990 May;40(334):182–185.

Analysis of referral behaviour: responses to simulated case histories may not reflect real clinical behaviour.

D C Morrell 1, M O Roland 1
PMCID: PMC1371274  PMID: 2114132

Abstract

In an attempt to develop a measure of the referral behaviour of general practitioners, 21 simulated case histories were constructed which presented between three and six stages at which a decision was required whether or not refer a 'patient' to hospital. Twenty general practitioners completed the case histories and their responses were compared with their referral rates to outpatient departments. No significant correlations were found between the doctors' responses to the vignettes and their actual referral rates, and the repeatability of the vignettes was disappointing. The fact that the case histories appeared realistic to the doctors who completed them was not reflected in objective measures of their validity. Simulated case histories should not be used as a method of measuring doctors' behaviour without establishing their validity and reliability.

Full text

PDF
182

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Chaput de Saintonge D. M., Hathaway N. R. Antibiotic use in otitis media: patient simulations as an aid to audit. Br Med J (Clin Res Ed) 1981 Oct 3;283(6296):883–884. doi: 10.1136/bmj.283.6296.883. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Chaput de Saintonge D. M., Hattersley L. A. Antibiotics for otitis media: can we help doctors agree? Fam Pract. 1985 Dec;2(4):205–212. doi: 10.1093/fampra/2.4.205. [DOI] [PubMed] [Google Scholar]
  3. Crombie D. L., Fleming D. M. General practitioner referrals to hospital: the financial implications of variability. Health Trends. 1988 May;20(2):53–56. [PubMed] [Google Scholar]
  4. Goran M. J., Williamson J. W., Gonnella J. S. The validity of Patient Management Problems. J Med Educ. 1973 Feb;48(2):171–177. doi: 10.1097/00001888-197302000-00007. [DOI] [PubMed] [Google Scholar]
  5. Howie J. G. Further observations on diagnosis and management of general practice respiratory illness using simulated patient consultations. Br Med J. 1974 Jun 8;2(5918):540–543. doi: 10.1136/bmj.2.5918.540. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Jacobs H. M., Kuyvenhoven M. M., Touw-Otten F. W., van Es J. C. Written simulation of patient-doctor encounters. 2. Assessment of the performance of general practitioners. Fam Pract. 1984 Mar;1(1):20–24. doi: 10.1093/fampra/1.1.20. [DOI] [PubMed] [Google Scholar]
  7. Jones R. H. Data collection in decision-making: a study in general practice. Med Educ. 1987 Mar;21(2):99–104. doi: 10.1111/j.1365-2923.1987.tb00673.x. [DOI] [PubMed] [Google Scholar]
  8. Kirwan J. R., Bellamy N., Condon H., Buchanan W. W., Barnes C. G. Judging "current disease activity" in rheumatoid arthritis--an international comparison. J Rheumatol. 1983 Dec;10(6):901–905. [PubMed] [Google Scholar]
  9. Kirwan J. R., Chaput de Saintonge D. M., Joyce C. R., Currey H. L. Clinical judgment in rheumatoid arthritis. I. Rheumatologists' opinions and the development of 'paper patients'. Ann Rheum Dis. 1983 Dec;42(6):644–647. doi: 10.1136/ard.42.6.644. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Kirwan J. R., Chaput de Saintonge D. M., Joyce C. R., Holmes J., Currey H. L. Inability of rheumatologists to describe their true policies for assessing rheumatoid arthritis. Ann Rheum Dis. 1986 Feb;45(2):156–161. doi: 10.1136/ard.45.2.156. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Kuyvenhoven M. M., Jacobs H. M., Touw-Otten F. W., van Es J. C. Written simulation of patient-doctor encounters. 1. Research instrument for registration of the performance of general practitioners. Fam Pract. 1984 Mar;1(1):14–19. doi: 10.1093/fampra/1.1.14. [DOI] [PubMed] [Google Scholar]
  12. Kuyvenhoven M. M., Jacobs H. M., Touw-Otten F. W., van Es J. C. Written simulation of patient-doctor encounters. 3. Comparison of the performance in the simulation with prescription and referral data in reality. Fam Pract. 1984 Mar;1(1):25–29. doi: 10.1093/fampra/1.1.25. [DOI] [PubMed] [Google Scholar]
  13. Newble D. I., Hoare J., Baxter A. Patient management problems. Issues of validity. Med Educ. 1982 May;16(3):137–142. doi: 10.1111/j.1365-2923.1982.tb01073.x. [DOI] [PubMed] [Google Scholar]
  14. Norman G. R., Feightner J. W. A comparison of behaviour on simulated patients and patient management problems. Med Educ. 1981 Jan;15(1):26–32. doi: 10.1111/j.1365-2923.1981.tb02311.x. [DOI] [PubMed] [Google Scholar]
  15. Page G. G., Fielding D. W. Performance on PMPs and performance in practice: are they related? J Med Educ. 1980 Jun;55(6):529–537. doi: 10.1097/00001888-198006000-00009. [DOI] [PubMed] [Google Scholar]
  16. Taylor T. R., Aitchison J., McGirr E. M. Doctors as decision-makers: a computer-assisted study of diagnosis as a cognitive skill. Br Med J. 1971 Jul 3;3(5765):35–40. doi: 10.1136/bmj.3.5765.35. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners

RESOURCES