Physicians’ Views of Unnecessary Care

The widespread belief that there is a lot of unnecessary care delivered in the United States has led to initiatives like Choosing Wisely, which is sponsored by the ABIM Foundation, which in turn is funded by the Robert Wood Johnson Foundation.  A survey of 600 doctors was commissioned by the foundation to ascertain physician views on unnecessary test and procedures.   (Dr. Survey)   Physicians agree that there is a problem with unneeded care, with 29% saying it is a very serious and 44% saying it is a somewhat serious problem.  However, 26% say it is not a serious problem.  About 72% think that the average physician orders an unnecessary test or procedure at least once a week.  In their own practices, 47% say a patient requests such care at least once a week and 30% say it happens to them several times a week.  Primary care doctors are more likely than physicians to report frequent patient requests for unneeded care.  Most doctors talk to their patients about such care, with 70% reporting that patients almost always follow their advice, but 27% say patients follow advice regarding such care less than half the time.  If patients are insistent, most doctors will ultimately order even a test or procedure they think is unnecessary, with only 40% saying they would still not order the care.

The primary reason given by doctors for order unnecessary tests and procedures is fear about malpractice, cited by 52%; wanting to be safe in their judgment, 36%; wanting more information for reassurance, 30%; patient insistence, 28% and keeping patients happy, 23%.  (Answers sum to more than 100% because physicians could list more than one important factor.)  Most doctors are very comfortable talking to patients about whether an item of care is really appropriate, with 87% saying they talk to patients about avoiding such care when the patient requests it.  But these discussions do not always include cost information, with only 20% saying they always or almost always include cost in the discussion.  And doctors think they do have responsibility to help avoid unnecessary care, with 58% thinking they are in the best position to do so.  Solutions to the problem offered by physicians include 91% who say malpractice reform would help; 85% who say more evidence-based recommendations would help, 78% who say having more time with patients and 61% who saying changing the system to avoid financial rewards for ordering such care.   Physicians who are aware of the Choosing Wisely campaign were more likely to deal strongly with the issue and to refuse to order unnecessary care.  The survey provides evidence again that doctor’s perceptions of malpractice liability are a primary cause of inappropriate care and this needs to be fixed to address the problem.