Seventy-five percent of doctors think their contemporaries order at least one unnecessary test or procedure a week, according to a survey by Choosing Wisely reported by writer Zack Budryk of Fierce HealthCare.
75% of Doctors Accuse Colleagues of Unnecessary Procedures
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The reasons physicians gave for ordering extraneous tests were malpractice concerns (52%), to be extra cautious (36%), to get more information so as to reassure themselves on their diagnosis (30%) and patient insistence on the procedure (28%). About 5% said they had been motivated by the fee-for-service system.
Budryk wrote that 47% of the respondents reported that one patient a week requests an unnecessary test or procedure. When that happens, 48% of the doctors reported that they advise the patient against it but eventually defer to the patient’s wishes.
“I think we’re afraid of not being liked, ” Donald Ford, M.D., a vice president at Hillcrest Hospital in Mayfield Heights, Ohio, told Kaiser Health News. “We want to be the hero to the patient.”
None of the doctors responding to the survey thought that Medicare was in the best position to address the problem and more than half (58%) put the responsibility for correcting the problem on the doctors themselves. More than three in four (78%) of those who responded said it would help to have more time to talk with patients and 61% said that changing the system of payment so physicians were not incentivized to order more tests would be effective.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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