Do general practitioners act consistently in real practice when they meet the same patient twice? examination of intradoctor variation using standardised (simulated) patients

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Abstract
Objective: To assess the variation within individual general practitioners facing the same problem twice in actual practice under unbiased conditions. Design: General practitioners were consulted during normal surgery hours by a standardised patient portraying a patient with angina pectoris. Six weeks later the same general practitioners were consulted again by a similar standardised patient portraying a similar case. The patients reported on the consultations. Setting: Trondheim, Norway. Subjects: Of 87 general practitioners invited by letter, 28 (32%) agreed to participate without hesitation; nine others (10%) wanted more information before consenting. From these 24 were selected and visited. Main outcome measures: Number of actions undertaken from a guideline 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 guideline score, 0.30 (8.1) for the total score, and −0.87 (9.01) for consultation time. Conclusions: The study shows that assessment of performance in real practice for a group of general practitioners is consistent from the first round of consultations to the second round. However, significant variation occurs in performance of individual physicians.