
                         Roanoke Times
                 Copyright (c) 1995, Landmark Communications, Inc.

DATE: TUESDAY, August 31, 1993                   TAG: 9309220306
SECTION: EXTRA                    PAGE: 3   EDITION: METRO 
SOURCE: DON COLBURN THE WASHINGTON POST
DATELINE:                                 LENGTH: Medium

A ROUTINE CHECKUP? DEPENDS ON THE DOCTOR

The standard doctor's office visit is not so standard, a study of 59 primary-care physicians in northern New England found. Trained actresses posing as 55-year-old patients overdue for most recommended routine medical tests and at risk for lung, breast and colorectal cancer requested a routine checkup but what they received varied widely in time, cost and content.

``Clearly, physicians offer no consistent response to a uniform request for a checkup,'' concluded the researchers, who reported their findings last month in the Annals of Internal Medicine.

The time devoted to the office visit ranged from five minutes to an hour. The fees ranged from zero - two doctors indicated it was their practice to provide an initial consultation at no charge for patients establishing ongoing care - to $108. The actresses kept track of whether their checkups included 14 recommended diagnostic tests. Most of the office visits were tape-recorded.

Blood-pressure measurement was the most-often-provided test. Mammograms, or breast X-rays, were taken on almost 90 percent of the patients. About 70 percent were tested for blood in the stools, 63 percent were scheduled for future pap smears to test for cervical cancer, 21 percent were given sigmoidoscopy to inspect the colon for evidence of cancer.

The patients had been instructed to say (if asked by the doctor) that they had smoked a pack a day for about 20 years, followed a high-fat, low-fiber diet and had a family history of breast and colon cancer.They also were told to say they had not had any medical care for at least three years - except for a pap test six months earlier at a community clinic.

During their checkups, all but four of the patients were asked if they smoked, but only 79 percent of those were advised to quit.

by CNB