75% of docs think peers order unnecessary tests and procedures

Most say they do it to avoid malpractice claims, err on the side of caution
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Seventy-five percent of doctors think their contemporaries order at least one unnecessary test or procedure a week, according to a new survey from Choosing Wisely.

Asked to rank the top reasons they themselves had ordered extraneous tests or procedures, 52 percent said malpractice concerns, 36 percent said they had ordered them just to be extra-cautious, 30 percent said to get more information to reassure themselves, 28 percent had patients who insisted on the unnecessary procedure, 13 percent wanted to leave the final decision up to their patients, and 5 percent were motivated by the fee-for-service system.

Forty-seven percent of respondents said one patient a week requests an unnecessary test or procedure. And 48 percent said that if a patient insists on an unnecessary procedure, they advise against it but defer to the patient, while 5 percent said they simply ordered the test.

"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."

Asked who is in the best position to solve the problem of unnecessary care, 58 percent of respondents said physicians, followed by 15 percent who said the government, 7 percent who said trial lawyers, 3 percent who said patients, 3 percent who said insurance companies and 1 percent who said hospitals. Zero percent of respondents thought Medicare or drug companies were in the best position to address the prblem, according to the survey results.

As far as practical solutions, more than three in four respondents (78 percent) said it would help to have more time to discuss alternatives with patients, and 61 percent said altering payment systems so physicians were not incentivized to order more tests would be effective.

A February study determined five common low-value, often unnecessary emergency procedures, including computed tomography of the head for mild traumatic head injury patients who are not high-risk and  anticoagulation studies for patients who do not have hemorrhage or suspected clotting disorder, FierceHealthcare previously reported.

To learn more:
- read the survey results (.pdf)
- read the response breakdown (.pdf)
- read the KHN article

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