Selection bias in the referral of patients and the natural history of surgical conditions

L. J. Melton

Research output: Contribution to journalArticle

88 Scopus citations


Patients are selected for referral to academic medical centers on the basis of age, severity of disease, presence of complications, and other factors. This selection process alters the clinical spectrum of diseases or surgical conditions as seen at major medical centers and, therefore, also influences the perceived natural history of these conditions. The resulting distortion between the natural history of a disease at large medical centers and that in the community is called selection bias. This selection bias can cause disagreement between practitioners in the community and those at teaching centers regarding the definition of and risk factors for various diseases, the utility of laboratory tests, the prognosis to be expected in a given group of patients, and the effectiveness of specific therapeutic or prophylactic procedures.

Original languageEnglish (US)
Pages (from-to)880-885
Number of pages6
JournalMayo Clinic Proceedings
Issue number12
StatePublished - 1985


ASJC Scopus subject areas

  • Medicine(all)

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