Most Docs Call Unneeded Tests, Procedures a Serious Problem

Rita Rubin, MA

May 02, 2014

Nearly three quarters of physicians recognize that unnecessary medical tests and procedures represent a serious problem for the US healthcare system, but more than half say they would give in to a persistent patient who wanted one, according to a survey released May 1 by the ABIM Foundation.

The "Choosing Wisely" telephone survey of 600 physicians nationwide, funded by the Robert Wood Johnson Foundation, was conducted in February and March by Perry Undem Research/Communication. The margin of sampling error is ±4 percentage points.

About 1 (21%) in 5 physicians surveyed said they were aware of the ABIM Foundation's 2-year-old Choosing Wisely campaign, which is designed to get specialty societies to develop lists of medical services that do not provide broad overall patient benefits but that still may be performed often. The goal is to phase out unnecessary use of these procedures or tests.

Other survey findings included that:

  • Nearly 3 (73%) in 4 physicians say the frequency of unnecessary tests and procedures is a very or somewhat serious problem.

  • Two thirds (66%) of physicians feel they have a great deal of responsibility to make sure their patients avoid unnecessary tests and procedures.

  • More than half (58%) of physicians say they are in the best position to address the problem, with the government a distant second (15%).

The Long Arm of the Campaign

Choosing Wisely has now reached nearly every medical subspecialty, Richard Baron, MD, president and chief executive officer of the ABIM Foundation, said at a press conference. The survey found that physicians who know about it are less likely to order unnecessary tests and procedures (44% vs 37% of those who have not heard about the campaign).

The Robert Wood Johnson Foundation last year funded grants to 21 medical societies, regional health organizations, and consumer advocates to educate physicians and patients about Choosing Wisely recommendations. Susan Mende, BSN, MPH, senior program officer at the foundation, says the 21 grant recipients have reached more than 170,000 physicians and 16 million consumers.

However, there is still work to be done. The survey findings suggest that many patients continue to request unnecessary tests and procedures and that many physicians continue to order them. For example:

  • Nearly half of physicians (47%) say their patients ask for an unnecessary test or procedure at least once a week.

  • Nearly 3 (72%) in 4 physicians say that the average medical physician prescribes an unnecessary test or procedure at least once a week.

  • More than half of the physicians surveyed (53%) say that even if they know a test is unnecessary, they will still order it if the patient insists.

  • However, almost 3 (70%) in 4 physicians say that after they speak with a patient about why a test or procedure is unnecessary, the patient often avoids it.

The problem is not limited to physicians, Baron says. He announced that the Choosing Wisely campaign will expand to nonphysician provider organizations later this year. The American Dental Association, American Physical Therapy Association, and American Academy of Nursing will release their own lists of medical tests and procedures that are commonly used in their professions but are of questionable value. Consumer Reports will work with each organization to help develop patient-friendly materials.

"It's really important to recognize that patients go lots of places for healthcare advice," Baron says.

"Thinking Differently"

On a panel after the press conference, Maine family practice physician John Barnes, MD, described how his practice has immersed itself for the past several months in Choosing Wisely campaign materials, including posters and education sessions with the entire staff.

"What we're trying to do is educate everybody about thinking differently," Dr. Barnes said. And, he added, that includes the entire town of Winthrop, a rural community of about 6000 people.

Dr. Barnes said he empathizes with the survey respondents who said they would give in to a persistent patient's request for unnecessary care. Similar to many primary care physicians, he regularly encounters patients who request an antibiotic prescription for what is clearly a viral infection. "I don't think you need it," Dr. Barnes tells such patients. "Let me explain."

That approach often works, he said. When it doesn't, he offers patients a proposition: He'll write them a prescription, but he asks that they stick it in their pocket and wait 3 days before filling it. He knows that many of them will feel better in that time and see no need to go on antibiotics.

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