Unwarranted Variation in Health Care

For the last several decades, geographic differences in the type and amount of medical services US patients receive have come under increased scrutiny by physicians, policy makers, and those who pay for medical care. Variations that do not appear to correlate with differences in patient demographics, preferences, or disease burden are termed “unwarranted.” Contributors to the February issue grapple with the causes of unwarranted variations in health care and the effects they have on the cost and quality of care. The authors also strive to identify solutions—from more research into the effectiveness of drugs, devices, and diagnostic services to quality-based models for physician payment.

Volume 16, Number 2: 89-152 Full Issue PDF
  • Case and Commentary
    Feb 2014

    The Importance of Quality of Life to Patient Decision Making in Breast Cancer Care

    Heather Macdonald, MD
    Nonmaleficence must not be sacrificed in the name of the patient’s autonomy, but there is no need to undertake needlessly invasive treatments for a small boost in protection against cancer recurrence if the patient does not wish to do so.
    Virtual Mentor. 2014;16(2):94-97. doi: 10.1001/virtualmentor.2014.16.2.ecas1-1402.
  • Case and Commentary
    Feb 2014

    Presenting Unwelcome Research Findings, Commentary 1

    Steven J. Ralston, MD, MPH
    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?”
    Virtual Mentor. 2014;16(2):98-101. doi: 10.1001/virtualmentor.2014.16.2.ecas2-1402.
  • Case and Commentary
    Feb 2014

    Presenting Unwelcome Research Findings, Commentary 2

    Hilda Bastian
    It is an understandable human reaction to feel defensive in the face of evidence that challenges one's practices, but it is imperative that we rise above this with a modicum of humility and ask the tough questions: what causes problems and how can we avoid them in the future?
    Virtual Mentor. 2014;16(2):101-102. doi: 10.1001/virtualmentor.2014.16.2.ecas2-1402.
  • Case and Commentary
    Feb 2014

    Is More Screening Always Better?

    Michael LeFevre, MD, MSPH
    All medical care should seek to achieve one or more of three goals: to prevent future suffering, to relieve suffering, or to prolong life. Detecting low-grade indolent cancer may not further any of these goals.
    Virtual Mentor. 2014;16(2):103-106. doi: 10.1001/virtualmentor.2014.16.2.ecas3-1402.
  • In the Literature
    Feb 2014

    A Resource-Based Locality Rule

    Stuart P. Swadron, MD, Peter Milano, MD, and Anne M. Milano, JD, CPA
    Standards of care may not consider the variation in resources available in a given location in a given instance.
    Virtual Mentor. 2014;16(2):111-114. doi: 10.1001/virtualmentor.2014.16.2.jdsc1-1402.
  • Health Law
    Feb 2014

    Lack of Standardized Informed Consent Practices and Medical Malpractice

    Richard Weinmeyer, JD, MPhil
    The ambiguity about and lack of uniformity in informed consent practices does not lend itself to the kind of shield from malpractice liability that exists in some more concrete, standardizable aspects of medical practice.
    Virtual Mentor. 2014;16(2):120-123. doi: 10.1001/virtualmentor.2014.16.2.hlaw1-1402.
  • Policy Forum
    Feb 2014

    Limiting Low-Value Care by “Choosing Wisely”

    William L. Schpero, MPH
    Although not everything on the Choosing Wisely lists is likely to reduce low-value care, it is a good starting point for a conversation about curtailing low-value interventions.
    Virtual Mentor. 2014;16(2):131-134. doi: 10.1001/virtualmentor.2014.16.2.pfor2-1402.
  • Medicine and Society
    Feb 2014

    Place: The Seventh Vital Sign

    Bill Davenhall, MA
    A digital record of place history and environmental context can provide a piece of clinically relevant information to help physicians understand what toxins patients may have been exposed to.
    Virtual Mentor. 2014;16(2):135-137. doi: 10.1001/virtualmentor.2014.16.2.msoc1-1402.
  • Viewpoint
    Feb 2014

    Does Location Determine Medical Practice Patterns?

    James Reschovsky, PhD
    Variations in medical practice are far more complex than the simple narrative popularly attributed to the Dartmouth Atlas.
    Virtual Mentor. 2014;16(2):138-141. doi: 10.1001/virtualmentor.2014.16.2.oped1-1402.
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    Podcast
    Feb 2014

    Ethics Talk: Unwarranted Variation in Health Care Services

    This month Virtual Mentor theme issue editor Elizabeth Miranda, a medical student at the Keck School of Medicine of the University of Southern California in Los Angeles, interviewed Dr. Elliott Fisher about the problem of unwarranted variation in health care services.