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Do Ophthalmologists, Anesthesiologists, and Internists Agree About Preoperative Testing in Healthy Patients Undergoing Cataract Surgery?
Eric B. Bass, MD, MPH;
Earl P. Steinberg, MD, MPP;
Rajiv Luthra, MD, MPH;
Oliver D. Schein, MD, MPH;
James M. Tielsch, PhD;
Jonathan C. Javitt, MD, MPH;
Phoebe D. Sharkey, PhD;
Brent G. Petty, MD;
Marc A. Feldman, MD, MHS;
Donald M. Steinwachs, PhD
Arch Ophthalmol. 1995;113(10):1248-1256.
Abstract
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To assess variation in reported use of preoperative medical tests in patients undergoing cataract surgery and to identify factors that influence test use by different physician groups we performed a national survey of ophthalmologists, anesthesiologists, and internists. Participants included randomly selected members of American professional societies who provided care to one or more patients undergoing cataract surgery in 1991. Responses were obtained from 538 (82%) of 655 eligible ophthalmologists, 109 (76%) of 143 anesthesiologists, and 54 (44%) of 122 internists. Fifty percent of ophthalmologists, 40% of internists, and 33% of anesthesiologists frequently or always obtained a chest x-ray film, while 20% of ophthalmologists, 27% of internists, and 37% of anesthesiologists never obtained a chest x-ray film for patients being considered for cataract surgery who had no history of major medical problems (P<.01 for differences between ophthalmologists and the other groups). Similarly, 70% to 90% of ophthalmologists, 73% to 79% of internists, and 41% to 79% of anesthesiologists frequently or always obtained a complete blood cell count, electrolyte panel, and electrocardiogram, while 4% to 11% of ophthalmologists, 13% to 17% of internists, and 9% to 28% of anesthesiologists never obtained these tests for such patients. Many respondents (32% to 80%) believed tests were unnecessary but cited multiple reasons for obtaining tests (eg, medicolegal concerns and institutional requirements). Many physicians in each group viewed preoperative evaluations as screening opportunities or believed that one of the other two types of physicians "required" tests. We conclude that marked variation exists within and across physician specialties in the use and rationale for use of medical tests in patients undergoing cataract surgery.
Author Affiliations
From the Departments of Medicine (Drs Bass, Steinberg, and Petty), Ophthalmology (Drs Luthra, Schein, and Tielsch), and Anesthesiology and Critical Care Medicine (Dr Feldman), The Johns Hopkins University School of Medicine, Baltimore, Md; Department of Health Policy and Management, The Johns Hopkins University School of Hygiene and Public Health (Drs Bass, Steinberg, and Steinwachs); The Worthen Center for Eye Care Research, Georgetown University Medical Center, Washington, DC (Dr Javitt); and Department of Information Systems and Decision Sciences, Sellinger School of Business, Loyola College, Baltimore (Dr Sharkey).
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