Views & Reviews From the Frontline

The cause of clinical variance

BMJ 2013; 346 doi: (Published 19 February 2013) Cite this as: BMJ 2013;346:f1122

Re: The cause of clinical variance

I quite agree with Des Spence that doctor’s personality does significantly influence their risk perception and consequent referral rates.(1). Doctors do tend to reflect the values and behaviours of the society as a whole. The fear of disease, certainly in western world, seems to be at odds with actual risk of various diseases. This is similar to the fear of crime where there is a large perception gap between the fear of crime and the actual crime rate itself.(2)

The gate keeping role of General practitioners (GPs) is coming under pressure from the ‘worried-well’ as the GPs are turning into ‘gatekeepers of risk factors’ rather than ‘gatekeepers of diseases’.(3)

1. Spence D. The cause of clinical variance. BMJ. 2013;346:f1122.

2. Moon D, Flatley J, Parfrement- Hopkins J, Hall P, Hoare J, Lau I, et al. Perceptions of crime, engagement with the police, authorities dealing with anti-social behaviour and Community Payback: Findings from the 2010/11 British Crime Survey. Home Office Statistical Bulletin. 2011.

3. Moynihan R, Doust J, Henry D. Preventing overdiagnosis: how to stop harming the healthy. BMJ. 2012;344:e3502.

Competing interests: No competing interests

05 March 2013
Santhanam Sundar
Consultant Oncologist