Patient requests drive unnecessary medical spending

By Matt Kuhrt

Despite lobbying through initiatives such as Choosing Wisely, unnecessary tests and procedures continue to drive up overall healthcare costs in the United States.

A part of the problem lies in our reliance on physicians to balance both high-quality, high-value care with their patients' expectations and satisfaction, according to a policy paper published in the American Journal of Managed Care.

Using data from the 2009 National Survey on Medical Professionalism, the paper seeks to ferret out the role patient requests play in the overprescription of brand-name drugs versus generics, as well as the tendency to refer patients to a specialist unnecessarily.

Among the findings:

  • More than half of respondents reported that they made referrals at patients' requests, despite a lack of indication
  • Patient requests drove more than a third of respondents to prescribe brand-name drugs unnecessarily when a generic was available
  • Among specialties, pediatricians were less likely than internal and family medicine physicians to prescribe brand-name drugs on patient request, though the authors note this is likely due to patient populations and standardized drug regimens for those patient populations
  • Physicians who met regularly with drug or medical device company representatives showed a "significant" tendency to acquiesce to patient requests for unnecessary care, though the specific reasons for this correlation remain unclear
  • Older physicians were reportedly more likely to prescribe brand-name drugs when patients requested that they do so
  • Smaller practices with one to two physicians were more likely to overprescribe brand-name drugs than larger practices, likely due to increased emphasis on patient satisfaction
  • Primary care physicians who deal predominantly with uninsured or Medicaid patients prescribe brand-name drugs for patient requests less frequently than other physicians, though the authors note these patients are both more likely to receive prescriptions for generic drugs and less likely to request brand-name drugs overall
  • There was no evidence that physicians in areas that spend more on healthcare overall are more likely to yield to patient requests for unnecessary care

Although physicians' prescribing behavior varied considerably by specialty, the authors suggested common root causes of their inclination to give in to patient requests, including time constraints and the desire to achieve customer satisfaction.

To learn more:
- check out the study