title: Do general practitioners act consistently in real practice when they meet the same patient twice? Examination of intradoctor variation using standardised (simulated) patients.
abstract: OBJECTIVE
  To assess the variation within individual general practitioners facing the same problem twice in actual practice under unbiased conditions.
  
  
  METHODS
  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.
  
  
  METHODS
  Trondheim, Norway.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of General Practice, University of Limburg, Netherlands.
authors.forename: J J
authors.initials: JJ
authors.lastname: Rethans
authors.forename: L
authors.initials: L
authors.lastname: Saebu
mesh_terms: D005194:Family Practice / Q000592:standards*; D006801:Humans; D009664:Norway; D016544:Patient Simulation; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation