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Medical Decision Making
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Judgment Analysis of Surgeons’ Prioritization of Patients for Elective General Surgery

Andrew D. MacCormick, MBChB

Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, New Zealand, andrew.maccormick{at}auckland.ac.nz

Bryan R. Parry, FRACS

Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, New Zealand

Background. Access to elective general surgery in New Zealand is governed by clinicians’ judgment of priority using a visual analog scale (VAS). This has been criticized as lacking reliability and transparency. Our objective was to describe this judgment in terms of previously elicited cues. Methods. We asked 60 general surgeons in New Zealand to assess patient vignettes using 8 VAS scales to determine priority. They then conducted judgment analysis to determine agreement between surgeons. Cluster analysis was performed to identify groups of surgeons who used different cues. Multiple regression for the combined surgeons was undertaken to determine the predictability of the 8-scale VAS.Results. Agreement between surgeons was poor (ra = 0.48). The cause of poor agreement was mostly due to poor consensus (G) between surgeons in how they weighted criteria. Using cluster analysis, we classified the surgeons into 2 groups: 1 took more account of quality of life and diagnosis, whereas the other group placed more weight on the influence of treatment. The 8-scale VAS showed good predictability in assigning a priority score (R2 = 0.66).Discussion. The level of agreement reflects surgeons’ practice variation. This is exemplified by 2 distinct surgeon groups that differ in how criteria were weighted.

Key Words: health care rationing • operative surgical procedures • waiting lists • judgment analysis • priority setting

Medical Decision Making, Vol. 26, No. 3, 255-264 (2006)
DOI: 10.1177/0272989X06288680
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[Abstract] [PDF]